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目的探讨关节镜下髌骨内侧支持带紧缩术(medial retinaculum plication,MRP)治疗青少年复发性髌骨脱位的临床疗效。方法对2000年3月-2007年10月收治的30例符合选择标准的青少年复发性髌骨患者进行前瞻性研究,其中28例获完整随访者纳入研究。男5例,女23例;年龄12～19岁,平均14.7岁。左膝12例,右膝16例。髌骨首次脱位至入院时间4～39个月,平均18.8个月。患者既往髌骨2～4次脱位。患者髌骨外推恐惧试验均为阳性,髌骨外移度为(2.9±0.7)°,髌骨外推无硬性终止点。国际膝关节文献委员会(IKDC)、Lysholm、Kujala以及Tegner评分分别为(47.7±3.7)、(52.6±4.9)、(66.7±5.9)和(3.1±1.3)分。患者均于关节镜下行MRP治疗。结果患者术后切口均Ⅰ期愈合,无感染或神经、血管损伤等早期并发症发生。患者均获随访,随访时间2～7年,平均4.8年。术后随时间延长,髌骨外推恐惧试验阳性患者数逐渐增加,24个月时为12例;髌骨外推有硬性终止点患者逐渐减少,24个月时为3例;髌骨外移度逐渐增加,24个月为(2.3±1.1)°;以上3项指标除髌骨外移度外,与术前比较差异均有统计学意义(P<0.05)。术后6例发生再脱位,23例出现单纯髌骨不稳。术后24个月IKDC、Lysholm、Kujala以及Tegner评分分别为(62.5±6.2)、(70.7±5.1)、(76.6±4.8)和(3.9±0.7)分,均较术前显著提高(P>0.05)。CT检查示,术后即刻患者髌股关节适配角、髌骨外侧角以及髌骨倾斜角均恢复至正常水平,但术后24个月与术前比较差异均无统计学意义(P>0.05);术后24个月髌骨外移距离与术前比较,差异有统计学意义(P<0.05)。结论关节镜下MRP治疗青少年复发性髌骨脱位虽在改善膝关节功能方面有一定疗效,但不能较好维持髌骨矫正后的位置。
Objective To investigate the clinical efficacy of arthroscopic patellar medial retinaculum plication (MRP) in the treatment of recurrent patellar dislocation in adolescents. Methods Thirty patients with recurrent patella of adolescent who meet the selection criteria were enrolled in the prospective study from March 2000 to October 2007, of which 28 were included in the study. 5 males and 23 females; aged 12 to 19 years old, with an average of 14.7 years old. Left knee in 12 cases, right knee in 16 cases. The first dislocation of the patella to admission time 4 to 39 months, an average of 18.8 months. Patients with previous patellar dislocation 2 to 4 times. Patient patella extrapolation fear test were positive, the patellar shift was (2.9 ± 0.7) °, patella non-rigid termination point. The IKDC, Lysholm, Kujala and Tegner scores were (47.7 ± 3.7), (52.6 ± 4.9), (66.7 ± 5.9) and (3.1 ± 1.3) points, respectively. Patients underwent arthroscopic MRP treatment. Results The incisions were all healed by first intention and no early complications such as infection or nerve injury and vascular injury occurred. Patients were followed up for 2 to 7 years, an average of 4.8 years. With the extension of time after surgery, the number of positive patients with patellar extrapolation fear test increased gradually, at 24 months, 12 cases; patients with patella extrapolation with rigid termination point gradually decreased, 24 cases at 3 months; the patellar shift gradually increased (2.3 ± 1.1) ° in 24 months. The above 3 indexes except for the patellar shift were significantly different from those before operation (P <0.05). Postoperative dislocation occurred in 6 cases, 23 cases of simple patellar instability. The IKDC, Lysholm, Kujala and Tegner scores at 24 months postoperatively were (62.5 ± 6.2), (70.7 ± 5.1), (76.6 ± 4.8) and (3.9 ± 0.7) ). CT examination showed that the patellofemoral joint adaptation angle, lateral patellar angle and patellar tilt angle recovered to normal level immediately after operation, but there was no significant difference between preoperation and postoperative 24 months (P> 0.05). The distance of patellar shift 24 months after operation was significantly higher than that before operation (P <0.05). Conclusions Although arthroscopic MRP treatment of recurrent patellar dislocation in adolescents has some effect in improving knee joint function, it can not maintain the correct position of patellar correction.