【摘要】 [目的]随访观察胫骨结节截骨前内侧移位术与内侧髌股韧带重建术治疗髌股关节炎早期临床疗效。[方法]随诊自2005年6～2008年9月,32例因髌股关节对合不良手术治疗的患者,其中14例患者行胫骨结节截骨前内侧移位术,18例行内侧髌股韧带重建术。术前术后进行手法检查髌骨稳定性。以Lysholm评分、IKDC主观评分、Kujala knee score进行膝关节功能评分。测量髌骨外移度及髌骨倾斜角。应用SAS统计软件包分析随访数据。[结果]随访时间12～36个月,平均23.5个月。术后手法检查髌骨稳定性:移位术后髌骨不稳发生率28.6%,重建术后为5.6%。术后髌骨稳定性重建组好于移位组,二者比较具有统计学差异。术后两组髌骨倾斜角和髌骨外移率均恢复至正常范围,两组比较无统计学差异。术后两组Lysholm评分、IKDC主观评分、Kujala knee score均明显高于术前评分,并且重建组好于移位组,二者比较有统计学差异。[结论]2种术式均明显提高髌骨稳定性,近端软组织重建能更明显改善膝前痛症状,且创伤小,恢复快,费用低,值得推荐。更多还原

【Abstract】 [Objective]To evaluate and compare clinical results of anteromedialization of the tibial tubercle and medial patellofemoral ligament reconstruction in patients with patellofemoral arthritis. [Method]Thrity-two patients were diagnosed as having malfunctional patellofemoral joint from July 2006 to July 2008 in our hospital.Fourteen patients were treated for anteromedialization of the tibial tubercle and eighteen patients received medial patellofemoral ligament reconstruction.The stability of the patella was examined before and after operation by physical examination.All patients were evaluated for the function of the knee by subjective questionnaire,including Lysholm score,IKDC score and Kujala knee score.Patellar lateral shift ratio and tilt were measured on CT scans. [Result]The follow-up time was from12 to 36 months,at an average of 23.5 months.Postoperative physical examination revealed patellar instability rate for anteromedialization was 28.6% in the tibial tubercle group and 5.6% in the medial patellofemoral ligament reconstruction group.Medial patellofemoral ligament reconstruction group has a better stability than that of the tibial tubercle group.There was a significant difference.Postoperative patellar lateral shift ratio and tilt in the two group returned to normal.There was no difference between the two group.Lysholm score,IKDC score and Kujala knee score were obviously increased postoperatively.The anteromedialization of the tibial tubercle was better than medial patellofemoral ligament reconstruction and it had a significant difference. [Conclusion]Both anteromedialization of the tibial tubercle and medial patellofemoral ligament reconstruction can improve patellar stability obviously,but medial patellofemoral ligament reconstruction should be recommended in the clinical practice.更多还原