臀肌挛缩松解联合髌骨支持带张力重建治疗弹响髋合并膝前痛

doi:10.13418/j.issn.1001-165x.2018.06.017

摘要/Abstract

摘要：

目的　探究在治疗臀肌挛缩合并膝前痛病症时恢复髌骨正常轨迹的必要性。方法　臀肌挛缩症合并膝前疼痛的患者30例，随机分为对照组16例(单纯行关节镜臀肌挛缩松解术)及实验组14例(行关节镜臀肌挛缩松解术联合内侧髌骨支持带紧缩及外侧支持带松解)。观察患者不同术式术后恢复情况，并比较手术前后WOMAC评分、Kujala评分、髌骨和谐角、外侧髌骨角以及并发症等。结果　术后2组30例均获得随访，平均随访时间14.3个月，切口均愈合良好。WOMAC评分、Kujala评分、髌骨和谐角、外侧髌骨角，对照组与实验组在术前评分均无明显差异(P>0.25)。两组术后1月、3月、6月患者WOMAC评分及髌骨和谐角较前明显降低(P<0.05)，Kujala评分及外侧髌骨角较前明显升高(P<0.05)。两组对比，术后1月、3月、6月实验组WOMAC评分、Kujala评分、髌骨和谐角、外侧髌骨角均优于对照组(P<0.05)。结论　关节镜下臀肌挛缩松解联合髌骨支持带重建较单纯关节镜下臀肌挛缩松解更能缓解长期臀肌挛缩导致的膝前痛等症状，且更好的减少髌骨外侧移位。

关键词: , 臀肌挛缩, 　膝前痛, 　髌骨脱位, 　关节镜, 　髌骨支持带

Abstract:

Objective　To investigate the necessity of restoring the normal trajectory of the humerus in the treatment of gluteal muscle spasm and anterior knee pain.　Methods　Thirty patients with orthopedic gluteal muscle contracture and anterior knee pain were randomly divided into a control group (n=16) (arthroscopic arthritis gluteal muscle contraction release) and an experimental group (n=14) (arthroscopic gluteal muscle contracture release combined with tightening of the medial patellofemoral reticulum and release of the lateral patellofemoral reticulum). Then the patients with different surgical methods were observed for postoperative recovery, and the WOMAC score, Kujala score, iliac bone harmony angle, lateral humeral angle and complications were compared before and after surgery.　Results　All the 30 patients in the 2 groups were followed up. The average follow-up period was 14.3 months. All incisions healed well. There were no significant difference between the control group and the experimental group in terms of the WOMAC score, Kujala score, iliac bone harmony angle, and lateral humeral angle (P>0.25). The WOMAC scores and tibia harmony angles of the patients in the two groups were significantly lower in the first month, third month, and sixth month after the operation (P<0.05). The Kujala score and lateral tibia angle were significantly higher than before (P<0.05). Compared with the control group, the WOMAC score, Kujala score, iliac bone harmony angle and lateral tibia angle of the experimental group were better than those of the control group in the first month, third month, and sixth month after the operation (P<0.05).　Conclusions　Arthroscopic gluteal muscle contraction released combined with patellofemoral reticulum can better relieve the symptoms of anterior knee pain caused by long-term gluteal muscle contracture and reduce the lateral displacement of the tibia.

Key words: Gluteal muscle contracture, 　Anterior knee pain, 　Patella dislocation, 　Arthroscopy, Humerus support band

贾川,徐建达,谢子康,瞿玉兴. 臀肌挛缩松解联合髌骨支持带张力重建治疗弹响髋合并膝前痛[J]. 中国临床解剖学杂志, 2018, 36(6): 683-689.

JIA Chuan, XU Jian-da, XIE Zi-kang, QU Yu-xing. Gluteal muscle contracture release combined with patellar reticulum tension reconstruction for the treatment of springing hip combined with anterior knee pain[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(6): 683-689.

参考文献

[1] 尤田, 张新涛, 张文涛, 等. 臀肌挛缩症发病机制的研究进展[J]. 中国矫形外科杂志, 2017, 24(13):1201-1203.
[2] 王承祥, 宫玉锁，李盛华, 等．臀肌松解术治疗臀肌挛缩导致膝骨性关节炎52例临床分析[J].中国骨伤, 2011, 24(7):594-596.
[3] 叶斌,陈友燕,张胜年,等.臀肌挛缩症患者髋关节肌肉力量的生物力学研究[J]. 中华全科医学, 2012, 10(11):1674-1676．
[4] 王承祥, 周明旺, 颜春鲁, 等. 臀肌挛缩症患者髌股关节影像学相关指标研究[J]. 中国中医骨伤科杂志, 2015, 23(3):14-16.
[5] 肇刚, 刘玉杰, 王俊良. 臀肌挛缩症伴膝前疼痛的病因分析及意义[J].中国骨伤, 2014, 27 (12):1000-1002.
[6] 李智勇, 路云翔, 陈郁鲜, 等. 臀肌挛缩症镜下分型及疗效分析[J]. 中国矫形外科杂志, 2016, 24(5):427-731.
[7] 符培亮, 吴宇黎, 吴海山, 等. 关节镜下内侧紧缩及外侧松解加半髌腱止点移位术治疗复发性髌骨脱位[J]. 中华关节外科杂志(电子版), 2014, 8 (1) :22-27.
[8] 高玉龙, 陈丽, 乔建民, 等. 屈膝30°体位CT扫描对青少年习惯性髌骨脱位的诊断价值[J]. 中国骨与关节损伤杂志, 2017, 32(3):327-328.
[9] Barton CJ, Lack S, Malliaras P, et al．Gluteal muscle activity and patellofemoral pain syndrome：a systematic review[J]. Br J Sports Med,2013,47(4):207-214．
[10]Barton CJ，Levinger P，Crossley KM，et al． The relationship between rearfoot，tibial and hip kinematics in individuals with patellofemoral pain syndrome[J]. Clin Biomech（Bristol,Avon）, 2012, 27(7):702-705．
[11]张磊, 张洪美, 陈卫衡, 等. 关节镜下外侧支持带松解治疗髌骨外侧高压综合征[J]. 中国骨伤，2004,17(8):458-460．
[12] Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics [J]. J Biomech, 2009, 42(10):1539-1546．
[13] 张兰花, 陈凯, 王培军. 臀肌挛缩症与髂骨致密性骨炎的关系[J]. 放射学实践,2011, 26(8): 872-874.
[14] 刘伟锋, 陈俊伟, 赖丽莎. 臀肌挛缩症的影像学回顾性分析[J]. 中国CT和MRI杂志, 2015, 13(4):112-116.
[15]倪滨, 李明.儿童臀肌挛缩对骨骼发育的影响[J]. 四川大学学报(医学版), 2007, 38(4): 657-659.
[16] 任士友, 江长青, 李伟, 等. 关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较的Meta分析[J].中国组织工程研究, 2014, 18(33):5407-5412．
[17] Kotha VK, Reddy R, Reddy MV, et al. Congenital gluteus maximuscontracture syndrome-a case report with review of imaging findings[J]. J Radiol Case Rep,2014, 8(4):32-37．
[18] 王乾君, 王宇泽, 王小虎, 等. 复发性髌骨脱位治疗的现状及进展[J].中国矫形外科杂志, 2015, 23(15):1392-1395.
[19] Song CY, Lin JJ, Jan MH, et al. The role of patellar alignment and tracking invivo: the potential mechanism of patellofemoral pain syndrome[J]. Phys TherSport, 2011, 12(3):140-147.
[20] 胡永超, 郭永智. 关节镜下髌骨外侧支持带松解内侧髌股韧带紧缩缝合术治疗髌股关节炎[J]. 中国矫形外科杂志, 2018, 26(9):810-814.
[21] 蒋仕林, 赵金忠. 髌骨稳定性的解剖学与生物力学研究进展[J]. 国际骨科学杂志, 2009, 30(1):15-17.
[22] Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics[J]. J Biomech, 2009, 42(10):1539-1546.
[23]陈辉, 王群, 燕双喜,等. 外侧支持带松解联合髌骨韧带重建修复复发性髌骨脱位[J]. 中国组织工程研究, 2015, 19(29): 4747-4751.
[24] Coons DA, Barber FA. Thermal medial retinaculum shrinkage and lat-eral release for the reatment of recurrent patellar instability[J]. Ar-throscopy, 2006, 22(2):166-171.
[25]Blackman AJ, Smith JC, Luhmann SJ. Arthroscopic lateral retinacular release in adolescents with medial patellofemoral ligament-centered knee pain[J]. J Pediatr Orthop, 2016, 36(3): 268-273.