改良三联术治疗复发性髌骨不稳疗效分析

目的探讨采用改良三联术治疗复发性髌骨不稳的效果。方法对21例复发性髌骨不稳患者采用关节镜下髌骨内侧支持带紧缩术和外侧支持带松解术,辅以改良Fulkerson截骨治疗复发性髌骨不稳。了解髌骨不稳复发、患膝主观症状以及患肢整体功能康复情况。结果术后随访1.5-12（6.75±5.25）个月,髌骨不稳无复发,4例仍有膝前疼痛,但症状较术前明显改善,手术前后IKDC膝关节功能主观评分分别为（36.2±4.7）分和（91.8±5.2）分（P〈0.01）,Lysholm膝关节功能综合评分分别为（41.9±6.2）分和（92.7±6.3）分（P〈0.01）,所有患者运动能力均较术前有所改善。术后X线检查对比：髌骨-股骨滑车适合角由术前的28.1°±7.9°改善为1.6°±8.1°（P〈0.01）,髌骨外侧关节面张开角从术前的-1.2°±7.3°改善为11.6°±4.2°（P〈0.01）。结论改良三联术治疗复发性髌骨不稳具有微创、可一并处理膝关节内其他病变、同时进行胫骨结节内移及抬高、减轻髌股关节压力、从根本上矫正解剖性或生理性股四头肌角（Q角）、手术技术易于掌握等优点。

Evaluation of the clinical effects of improved three associated techniques for recurrent patella instability

Objective To study the clinical effects of improved three associated techniques for recurrent patella instability. Methods 21 cases of recurrent patella instability were treated by improved three associated techniques, namely arthroscopie patellar medial retinaculum tightening, lateral retinaeulum releasing and improved Fulkerson osteotomy. Results The patients were followed up for 1.5 - 12 （6. 75 ± 5.25 ） months. The rate of recurrence, the subjective symptoms and the function of the injured leg were evaluated according to the IKDC and Lysholm rating scale. X-ray examination was taken to evaluate the patella-femur congruence. There was no recurrence at the last follow-up. Anterior knee pain, though in slight degree, still existed in 4 cases. The IKDC subjective knee scores were 36. 2 ± 4. 7 and 91.8 ± 5.2 （ P 〈 0. 01 ）. and the Lysholm knee score were 41.9 ± 6. 2 and 92. 7 ± 6. 3 （ P 〈 0. 01 ） before and after surgery respectively. The mobility improved in all cases. The Tegner sportlevel was 6. 8 ± 1.1 and 7.1 ± 0. 9 respectively before the first dislocation and after surgery. X-ray examination showed that the patella-femur congruence angle improved from 28. 1 °± 7.9 ° to 1.6 °± 8.1 °（ P 〈 0. 01 ）and the lateral patella angle was improved from - 1.2°± 7.3 ° to 11.6 °± 4. 2° （ p 〈 0. 01 ） on average. Conclusions Improved three associated techniques for recurrent patella instability has the advantages of less trauma and ability to treat associated pathological changes in knee. The tibial tubercle is positioned medially and elevated and the pressure in patellofemoral joint is reduced. The quadriceps angle was corrected fundamentally. The technique of operation can be grasp easily.