[1]石磊,夏春**,王少杰,等.改良Fulkerson截骨内移联合关节镜下髌骨支持带平衡术治疗髌骨复发性脱位[J].中国微创外科杂志,2013,13(5):439-443.
　Shi Lei,Xia Chun,Wang Shaojie,et al.Modified Fulkerson’s Osteotomy and Medial Transfer Combined with Arthroscopic Retinaculum Balancing for Recurrent Patella Dislocation[J].Chinese Journal of Minimally Invasive Surgery,2013,13(5):439-443.
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改良Fulkerson截骨内移联合关节镜下髌骨支持带平衡术治疗髌骨复发性脱位()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
13
期数:
2013年5期
页码:
439-443
栏目:
出版日期:
2013-05-20

文章信息/Info

Title:
Modified Fulkerson’s Osteotomy and Medial Transfer Combined with Arthroscopic Retinaculum Balancing for Recurrent Patella Dislocation
作者:
石磊; 夏春**; 王少杰; 傅日斌; 林劲松
厦门大学附属中山医院关节外科，厦门361004
Author(s):
Shi Lei;  Xia Chun;  Wang Shaojie;  et al.
Department of Joint Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004, China
关键词:
关节镜; 髌骨外侧松解; Fulkerson截骨内移; 髌骨复发性脱位
Keywords:
Arthroscopy; Retinaculum balancing; Fulkerson’s osteotomy and medial transfer; Recurrent patella dislocation
分类号:
R681.8
文献标志码:
A
摘要:
目的探讨关节镜下髌骨支持带平衡联合改良Fulkerson截骨内移术治疗髌骨复发性脱位的疗效。方法2004年3月~2012年1月对43膝(31例)复发性髌骨脱位行关节镜下探查和髌骨外侧松解术，同期行改良Fulkerson截骨内移术。先行关节镜下探查，7膝髌骨嵴或内侧部骨软骨缺损，面积约0.8～2.0 cm2，陈旧性血痂或不规则的软骨覆盖，伴有游离的骨软骨块，取出；另有5膝关节软骨严重损伤(Outerbridge Ⅲ~Ⅳ级），11膝轻中度软骨损伤(Ⅰ～Ⅱ级)，予软骨成形处理，然后在镜下松解髌骨外侧支持带及紧张的外侧结缔组织；再取胫骨结节外侧纵向切开约5 cm长，行改良Fulkerson截骨内移术，内移距离约2 cm，先用3枚克氏针临时固定后，用3枚空心拉力螺钉固定，术中检查髌骨运动轨迹和稳定性。术后早期主被动活动患膝关节，扶拐6周后负重行走。结果术后平均随访39个月（12～71个月），无一例再脱位，平均屈曲活动度丢失8°（0～25°），Lysholm评分从术前(44.5±10.9)分改善到(84.3±7.8)分差异（t=24.866，P=0.000）；Tegner活动评分从术前（3.8±0.8）分提高至（7.9±0.7）分（t=22.157，P=0.000）。Q角由术前20.5°±2.5°减小至术后12.5°±1.4°（t=18486，P=0.000），X线显示均已骨性愈合。结论关节镜下髌骨支持带平衡术联合改良Fulkerson截骨内移术创伤小，可有效改善复发性脱位髌骨稳定性，进而缓解症状，改善患肢功能。
Abstract:
ObjectiveTo study the effects of the modified Fulkerson’s osteotomy and medial transfer combined with patella retinaculum balancing on the recurrent patella dislocation. Methods43 knees (31 cases), treated between March 2004 and January 2010, were involved. After arthroscopic exploration and lateral retinaculum loosening were completed, modified Fulkerson’s tibial tubercule osteotomy and medial transfer were carried out. By arthroscopic exploration, cartilage defects were found in 7 knees in the patella crest or medial face with an area of 0.8-2.0 cm2, covered with old coagulations or irregular cartilage, with free osteochondral bodies that were removed during the arthroscopy. Besides, 5 cases of severe cartilage damage(Outerbridge grade Ⅲ-Ⅳ) and 11 cases of slight to moderate cartilage damage(grade Ⅰ-Ⅱ) were found and debridement were then completed. Consequently, the lateral retinaculum was loosened. Finally, a longitudinal cut of about 5 cm was made lateral to the tibial tubecule, and the modified Fulkerson’s osteotomy was carried out. The medial transfer was 2 cm in distance. After the temporary fixation of 3 Kirschner wires, a permanent fixation was reached with 3 hollow lag screws. Patella stability and movement were examined during the operation. The knee was moved passively and actively early postoperatively, and weight burdening was permitted after 6 weeks of stick aid. ResultsDuring the followup of 39 months in average(12-71 months), no reoccurrence was encountered. The average loss of range of motion(ROM)was 8 degrees（0-25 degrees) and the Lysholm scoring was (44.5±10.9) points and (84.3±7.8) points pre and postoperatively, with a significant statistical difference(t=24.866，P=0.000). Tegner action scoring was （3.8±0.8） and （7.9±0.7） points pre and postoperatively, also with a significant difference（t=22.157，P=0.000）. Bone healing was proved by Xray examinations. ConclusionsModified Fulkerson’s osteotomy and medial transfer combined with arthroscopic patella retinaculum balancing can significantly improve the stability of the impacted patella, which can relieve symptoms and improve the function of the affected limbs. It has been proved to be a minimally invasive method to treat recurrent patella dislocation.

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备注/Memo

备注/Memo:
基金项目：福建省医学创新课题，编号:2011-CXB-36;福建省自然科学基金面上项目,编号:2010D007，**通讯作者，Email:chunxia99@yahoo.com.cn
更新日期/Last Update: 2014-01-08