| 改良髌三联手术治疗早期髌股关节炎 |
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Received:February 10, 2025
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| 期刊信息：《中国骨伤》2025年38卷，第5期，第517-524页 |
| DOI：10.12200/j.issn.1003-0034.20240054 |
| 基金项目:浙江省湖州市医学重点学科建设项目(编号:CXXK-HT-202309A) |
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目的:探讨关节镜下髌外侧支持带松解、改良内侧髌股韧带重建和改良Fulkerson截骨术治疗早期髌股关节炎的临床疗效。
方法:回顾性分析2018年3月至2022年6月收治的髌股关节炎患者57例,男22例,女35例;年龄22~45(31.5±5.7)岁;病程2~8(3.7±2.2)年;左侧19例,右侧38例。采用取自体同侧腓骨长肌腱的一半做肌腱移植体,在关节镜下行髌外侧支持带松解术,合并行改良内侧髌股韧带重建和改良Fulkerson截骨术。比较术前及术后12个月Q角、髌骨倾斜角、胫骨结节-股骨滑车沟(tibial tuberosity-trochlear groovedistance,TT-TG)及Lysholm膝关节评分变化情况。
结果:所有患者切口Ⅰ期愈合,57例患者获得随访,时间12~36 (22.1±2.5)个月。Q角、髌骨倾斜角、TT-TG值分别由术前的(22.7±1.9)°、(29.2±2.0)°、(23.3±1.4) mm,改善至术后12个月的 (14.6±2.2)°、(7.6±3.2)°、(11.8±1.7) mm,差异有统计学意义(P<0.05);Lysholm评分由术前的(65.1±8.7)分提高至术后12个月的(86.8±7.2)分,差异有统计学意义(P<0.05),其中优41例,良15例,一般1例。
结论:通过改良内侧髌股韧带重建术和外侧支持带松解术治疗早期髌股关节炎可矫正Q角,改良Fulkerson截骨术矫正TT-TG值,抬高髌骨,缓解髌股关节的压力,减轻膝前疼痛,临床疗效确切。 |
| [关键词]:关节镜 髌三联手术 髌股关节炎 Fulkerson截骨术 |
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| Modified patellar triple surgery for early patellofemoral osteoarthritis |
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Abstract:
Objective To exploring the efficacy of modified patellar triple surgery (including arthroscopic lateral retinaculum release,modified medial patellofemoral ligament reconstruction,and modified Fulkerson osteotomy) in the treatment of early patellofemoral osteoarthritis.
Methods A retrospective analysis was conducted on 57 patients with patellofemoral arthritis admitted from March 2018 to June 2022,including 22 males and 35 females;aged 22 to 45 years old,average (31.5±5.7) years old; disease course 2 to 8 years (3.7±2.2) years;19 on the left side and 38 on the right side. The tendon graft was taken from the long tendons of the ipsilateral tibia,and the lateral patellar support band release was performed arthroscopically,combined with modified medial patellofemoral ligament reconstruction and modified Fulkerson osteotomy. The changes of Q angle,patellar tilt angle,tibial tuberosity-femoral trochlear groove (TT-TG) and Lysholm knee joint scores before and 12 months after surgery were compared.
Results All patient incisions healed in stageⅠ,and 57 patients were followed up for 12 to 36 with an average of (22.1±2.5) months. The Q angle,patellar inclination angle,and TT-TG values improved from (22.7±1.9)°,(29.2±2.0)°,and (23.3±1.4) mm before surgery to (14.6±2.2)°,(7.6±3.2)°,and (11.8±1.7) mm one year after surgery,with statistically significant differences (P<0.05). The Lysholm score increased from preoperative (65.1±8.7) to postoperative (86.8±7.2) at 1 year (P<0.05),with 41 cases being excellent,15 cases being good,and 1 case being average.
Conclusion The improvement of medial patellofemoral ligament reconstruction and lateral retinaculum release can correct the Q angle in early patellofemoral osteoarthritis,while the improvement of Fulkerson osteotomy can correct the TT-TG value,elevate the patella,relieve pressure on the patellofemoral joint,and alleviate anterior knee pain. The clinical efficacy is definite,providing ideas for the clinical treatment of patellofemoral osteoarthritis. |
| KEYWORDS:Arthroscopy Triple patellar surgery Patellofemoral osteoarthritis Fulkerson osteotomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 邬博来,燕晓宇.改良髌三联手术治疗早期髌股关节炎[J].中国骨伤,2025,38(5):517~524 |
| 英文格式: | WU Bo-lai,YAN Xiao-yu.Modified patellar triple surgery for early patellofemoral osteoarthritis[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(5):517~524 |
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