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缝匠肌前移治疗髌股关节痛 |
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陈秋生 朱立新 陈霞 周初松
【摘要】 目的 探讨髌股关节痛、髌骨软骨软化症的治疗方法。方法 游离缝匠肌下1/3段, 其止点不切断，前移，建立一动力性髌韧带，加强股内侧肌肌力，产生髌骨向内可变拉应力，使Q角变小，恢复髌股关节面的正常生物力学应力分布，恢复髌骨在股骨滑车和髁间沟内的矢状面、冠状面的正常滑动。结果 随访7例8膝，随访时间3年6个月～6年。临床症状消失，关节伸屈活动正常。结论 该方法适用于髌股韧带外侧紧张、内侧松驰、Q角大于正常角所引起的髌骨软骨软化症、髌骨半脱位、复发性髌骨脱位的治疗。
【关键词】 髌骨；骨软化症；缝匠肌；腱转移术
【中图分类号】 R687.2
Treatment of arthrodynia of patellofemoral joint by artero-transposition of sartorius muscle
Chen Qiusheng，Zhu Lixin, Chen Xia, Zhou Chusong
(Department of Orthopaedics, Zhujiang Hospital, The 1st Military Medical University, Guangzhou, Guangdong 510282)
【Abstract】 Objective To investigate the methods of treating pain in patellofemoral joint and chondromalacia of patella. Methods Q angle was decreased by establishing dynamic patella ligament with artero-transposition of sartorius muscle with its insertion intactness so that the tension force in the medial aspect of the patella increased, the normal stress distribution in the patellofemoral joint was restored, and the glide range of the patella in the femoral block and intercondylus ditch became normal. Results 7 cases(8 knees)were followed up for 3.5～6.0 years. The extersor-flexion function of the knees were normal without secondary degeneration of the patellofemoral joint. Conclusion The method is suitable for the treatment of the chondromalacia of patella with the relaxation of internal patellofemoral ligament and the overstrain of its external part,accompanying Q angle augmentation and the half dislocation of patella and the recurrent dislocation of patella.
【Key words】 patella; osteomalacia; sartorius muscle; tendon transfer
髌股关节痛是常见病〔1〕，早期髌骨软骨软化症若得不到很好的治疗，即可发展为髌股关节炎，引起髌股关节痛。目前治疗方法很多，效果却不尽人意。我们于1978年10月～1995年3月用改良术式治疗8例10膝，获得满意疗效。
1 材料与方法
1.1 病例资料 本组8例，10膝。男2例，女6例。年龄 23～41岁。临床表现:关节不适,酸软无力,有不稳定感,半蹲、下楼时重,有捻磨痛、磨擦感,髌骨两侧缘有压痛，内侧明显。膝伸直位,髌骨向内推移有阻力,股四头肌保护性痉挛,不同程度肌萎缩。Q角明显增大。屈膝30°轴位X线片示髌股关节面间隙外侧较内侧窄，髌骨轻度倾斜。
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