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1、中华骨科杂志2006年8月第26卷第8期ChinJOrthop,August2006,Vol.26,No.8·509··关节镜技术·自体半腱肌腱游离移植重建内侧支持带治疗复发性髌骨脱位刘玉杰薛静周密李众利王志刚李海鹏蔡谞【摘要】目的探讨关节镜下外侧髌股支持带松解和自体肌腱游离移植重建内侧髌股支持带治疗复发性髌骨脱位的疗效。方法复发性髌骨脱位18例,男6例,女12例。年龄17～24岁,平均20岁。关节镜下软骨Ⅳ度损伤者7例采用刨削打磨后微骨折术,软骨损伤Ⅱ度6例和Ⅲ度5例采用射频气化清理。外侧髌股支持带充分松解后,采用自体半腱肌腱游离移植重建内侧髌股支持带,关节镜下动态调整移植肌腱在不同
2、角度下屈伸活动时的张力和髌骨运动轨迹,观察股骨滑车与髌骨的对应关系。采用可吸收界面螺钉将肌腱端固定于股骨内收肌结节的骨道内。结果所有患者术后均获随访,平均13个月(9～19个月)。术后膝关节稳定性增加,无髌骨再脱位发生。恐惧试验阴性,髌骨倾斜试验对称,髌股关节研磨试验阴性16例,阳性2例。1例术后髌骨下极骨折,经手术后功能恢复正常。髌骨轴位X线片和MRI显示髌股关节解剖关系恢复正常15例,髌骨轻度半脱位3例。Lysholm评分术前平均(78.0±4.5)分,术后(94.0±3.5)分。结论关节镜下外侧髌股支持带松解与自体肌腱游离移植重建内侧髌股支持带治疗复发性髌骨脱位,方法简便,对于维
3、持髌骨的运动轨迹具有重要作用。【关键词】关节镜检查;髌骨脱位;膝关节LateralretinaculumpatellaesolutionandmedialpatellofemoralligamentreconstructionusingthesemitendinosustendonfreegraftedforthetreatmentofrecurrentdislocationofthepatellaLIUYu-jie,XUEJing,ZHOUMi,etal.DepartmentofOrthopaedicSurgery,GeneralHospitalofPLA,Beijing100853
4、,China【Abstract】ObjectiveToinvestigatetheoutcomesofarthroscopicallylateralretinaculumpatellaereleaseandmedialpatellofemoralligamentreconstructionusingthesemitendinosustendonautograftforthetreatmentofhabitualorrecurrentdislocationofthepatella.Methods18casesofrecurrentdislocationofthepatellawerein
5、cludedinthisgroup,amongwhichtherewere6malesand12females.Theaverageagewas20yearsold(rangefrom17to24years).Arthroscopicinvestigationfoundtensedlateralretinaculumpatellaeanddamagedcartilageatpatellarmedialmarginandfemorallateralcondyle.Therewere6casesofⅡdegreecartilageinjuries,5casesofⅢdegreesinjur
6、ies,and7casesofⅣdegreeinjuriescausedbypatellofemoraljointimpact.ForcasesofⅣdegreeinjuries,thedamagedcartilagewasshavedandmi-crofractured.ForcasesofⅡorⅢdegreeinjuries,radiofrequencysystemwasusedfordebridement.Afterthelateralretinaculumpatellaewasextensivelyreleased,semitendinosustendonautograftwa
7、susedtorecon-structthemedialpatellofemoralligament.Thekneejointwasflexedandextended.Patella'sdynamicmotion,thetensionofthetendonandrelationshipbetweenthefemoraltrochleaandpatellarbonewerearthroscopi-callyobserved.Interfacesc
