234生生置型塞盍垫15生3旦筮3鲞筮3期￡h血』Q吐hQB丛a血2Q15:yQ!1 35,丛!:3 急性滑脱性髌股关节撞击 综合征的关节镜下治疗 临床论著【摘要】 目的探讨急性滑脱性髌股关节撞击综合征的损伤机制、MRI诊断特征以及关节镜下诊治方法。方法 2005年9月至2012年10fJ应用改良髌内侧支持带紧缩缝合治疗急性滑脱性髌股关节撞击综合征46例,男9例,女37例; 年龄15~3l岁,平均21.6岁。术前常规行膝关节x线及MR检查,测量Q角、外侧髌股角及髌骨外移度。MRI髌内侧支持 带损伤按照Schweitzer分级标准:I度15例、度18例、度8例、度5例。手术于关节镜监视下施行,清除关节内积血, 关节内探查,取出游离软骨和骨软骨碎片,软骨成形,修整损伤软骨面。对髌内侧支持带l度损伤者行关节镜下清理及髌 内侧支持带固缩。对髌内侧支持带~度损伤伴明显髌骨移位者采用改良髌内侧支持带紧缩缝合术,对受伤时间超过 2周的9例同时行髌外侧支持带松解。对髌内侧支持带度损伤者行切开加固缝合。结果急性滑脱性髌股关节撞击综 合征的关节镜下表现包括关节内血肿46例、股骨外髁和髌骨内侧骨软骨损伤37例、游离体形成28例及髌内侧支持带撕 裂46例。所有病例均获得随访,随访时间12—36个月,平均18.2个月,无感染、神经血管损伤和再脱位等并发症发生。手 术前后Lysholm膝关节评分、Tegner膝关节运动水平评分、AA0s膝关节评分、外侧髌股角及髌骨外移度的差异有统计学意 义,患者运动功能均较术前有所改善。结论关节镜下改良髌内侧支持带紧缩缝合辅助髌外侧支持带松解术,是治疗急 性滑脱性髌股关节撞击综合征髌内侧支持带一度损伤的有效方法,有利于恢复膝关节功能,近期疗效好。 【关键词】关节镜检查;髌骨;创伤与损伤 【证据等级】治疗性研究级 The arthroscopic diagnosis acutepatellofemoral joint impingement syndrome Zhu Bo,Zhao Li Zhao Jinyan,Wang Zengliang.Department ofArthroscopyTianjin Hospital死。蟛凡300211,China 【Abstract】0bjective To explore acutepatellofemoral joint impingement syndrome itsarthroscopic diagnosis treatment.MethodsThere were atotal 46cases f9 males 37females) acutepatellofemoral ioint impingement syndrome from September 2005 October2012 ourdepartment,and averageage 21.6years old franging from 15 31years old).The Qangle,lateral patellofemoral angle(LPA)and lateraI shift distance fLSDl a11cases were measured MRIpreoperatively.MRI checked medialpatellar retinaculum injury 4de—grees:15 cases degreeI.18 cases degree,8cases degree1V.A1l operations were monitored under arthroscopy.Firstly,the hemarthrosis cleared.andsecondly arthroscopy exploreall around inside joints,the fme cartilage osteochondralfragment were taken out.and impairedsurface repaired.Medialpatellar reti— nacululrl treatedarthroscopically radiofrequency ablation degreeIinjury.Lateral patellar retinaculum releasedwhen longerthan 2weeks f9 eases).and medial capsule retinaculumstructure were reefed modifiedarthroscoDv assistance medialpatellar retinaculum injury degree1I obviouspatellar shih.The medi— al capsule retinaculumstructure were strengthened opensurgical method degreeIV injury.Results Con— stant findings under arthroscopy were haemarthrosis(46 cases),chondrM lesions involved lateralfemoral condyle medi—al marginal patella(37cases),osteochondral fragments(28 cases),and tear medicalretinaculum(46 cases).All patients were available follow—up。theaverage duration 18.2months(ranging from 12-36 months).No infection,nerve bloodvessel iniury,redislocation othercomplications happened.Lysholm,Tegner AAOSscores were used both preoper— ativelv Dostoperatively.andLPA LSDwere compared.Statistically,the difference between twoScores signifi—cant(P<0.05).The spoil ability improvedamong all patients.Conclusion Acute patellofemoral joint impingement syndrome can treatedeffectively modifiedsuture medialcapsule retinaculumstructure combined lateralretinacu— lnm.The function ot knee ioint recovered well after operation satisfactoryobjective snbjectiveeffeCtS. 【Key words】 krthroscopy;Patellar;Wounds injuries