CAJ | 학술논문

目的：探讨胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效。方法自2008年至2012年对12例复发性髌骨脱位行关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术。术后6周、3个月、6个月、12个月、2年、5年进行门诊随访，物理检查包括髌骨内移度检查，髌骨外推恐惧试验，复查轴位X线片了解截骨块愈合情况、髌股关节适合角、髌骨指数，Lysholm膝关节功能评价表、IKDC评分和Kujala评分表进行评估。结果所有患者均获随访，随访时间1～5年，平均2.0年。术后3～6个月复查X线片见截骨块以达到骨性愈合，在负重行走并行膝关节屈伸功能锻炼，膝关节功能恢复良好。术后髌骨内移度均介于1°～2°之间，术后各时间点髌骨外推恐惧试验阳性率、髌骨适合角、髌骨指数与术前比较，差异均有统计学意义（P＜0.05）；术后各时间点间比较，差异均无统计学意义（P＞0.05）。术后6、12个月，IKDC、Lysholm、Kujala评分均较术前显著提高，差异均有统计学意义（ P＜0.05）。术后6、12个月IKDC、Lysholm评分比较，差异无统计学意义（ P＞0.05）。术后12个月Kujala评分较术后6个月显著提高，差异有统计学意义。结论关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术能够有效治疗复发性髌骨脱位。
목적：탐토경골결절내이태고술연합관절경하빈골지지대조정술치료복발성빈골탈위적료효。방법자2008년지2012년대12례복발성빈골탈위행관절경하빈골외측지지대송해、내측지지대긴축연합경골결절내이태고술。술후6주、3개월、6개월、12개월、2년、5년진행문진수방，물리검사포괄빈골내이도검사，빈골외추공구시험，복사축위X선편료해절골괴유합정황、빈고관절괄합각、빈골지수，Lysholm슬관절공능평개표、IKDC평분화Kujala평분표진행평고。결과소유환자균획수방，수방시간1～5년，평균2.0년。술후3～6개월복사X선편견절골괴이체도골성유합，재부중행주병행슬관절굴신공능단련，슬관절공능회복량호。술후빈골내이도균개우1°～2°지간，술후각시간점빈골외추공구시험양성솔、빈골괄합각、빈골지수여술전비교，차이균유통계학의의（P＜0.05）；술후각시간점간비교，차이균무통계학의의（P＞0.05）。술후6、12개월，IKDC、Lysholm、Kujala평분균교술전현저제고，차이균유통계학의의（ P＜0.05）。술후6、12개월IKDC、Lysholm평분비교，차이무통계학의의（ P＞0.05）。술후12개월Kujala평분교술후6개월현저제고，차이유통계학의의。결론관절경하빈골외측지지대송해、내측지지대긴축연합경골결절내이태고술능구유효치료복발성빈골탈위。
Objective To evaluate the results of a tibial tubercle anteromedial transfer technique and arthroscopic patellar retinaculum adjustment in the treatment of recurrent patellofemoral dislocations . Methods The study included 12 knees of 12 patients ( eight males , four females;mean age of 20 years;range, 17 to 28 years ) who were operated on by the same surgeon for the patellofemoral alignment disorders.All the knees were treated by arthroscopic patellar retinaculum adjustment including the medial retinaculum placation , lateral retinaculum releasing , and the tibial tubercle anteromedial transfer .The follow-up period was from three weeks to 12 months postoperatively .The axial radiographic scans were done to measure the bone healing at the site of osteotomy , the patellar congruence angle and patellar index;Lysholm knee score , IKDC score and Kujala score were also evaluated .Results The mean follow-up period was two years ( range, one to five years ) .The radiographic scans showed that the osteotomy site achieved bone healing in three to six months after the surgery .The function of the knee was very well .The medial shift of the patella was 1°-2°postoperatively.At each postoperative time point, the positive apprehension test of patella , the patellar congruence angle , and the patellar index were statistically significant ( P<0.05) compared with the preoperative data .The comparison between the time points after the surgery showed no significant differences (P>0.05).In the 6th and 12th month after the surgery, IKDC, Lysholm, and Kujala scores were significantly improved compared with the preoperative ones , and the differences were statistically significant (P<0.05).Yet comparing the data of the postoperative 6th and 12th month, the differences of the IKDC , Lysholm scores between the two time points were not statistically significant (P >0.05).The postoperative Kujala score of the 12th month was remarkably improved, compared to that of the 6th month, and the difference was statistically significant .Conclusion The arthroscopic patellar retinaculum adjustment including the medial retinaculum plication , the lateral retinaculum releasing , and the tibial tubercle anteromedial transfer , may provide successful results in the treatment of the recurrent dislocation of the patella .