经皮髌骨肌腱清创术治疗顽固性髌腱病：2 年最低随访后的适应证、技术和临床结果。
Open Patellar Tendon Debridement for Treatment of Recalcitrant Patellar Tendinopathy: Indications, Technique, and Clinical Outcomes After a 2-Year Minimum Follow-up.
机构信息
Massachusetts General Hospital, Boston, Massachusetts.
出版信息
Sports Health. 2013 May;5(3):276-80. doi: 10.1177/1941738112467950.
BACKGROUND
Patellar tendinopathy can be treated surgically for patients that have failed at least 1 year of nonoperative treatment who continue to have debilitating symptoms. Patellar tendinopathy can cause significant functional deficits, yet little has been reported about the operative treatment of patellar tendinopathy.
HYPOTHESIS
A combined arthroscopic and open surgical technique for the treatment of recalcitrant patellar tendinopathy results in an improvement in function and pain at a minimum 2-year follow-up. The purpose of this study was to present the indications, combined surgical technique, rehabilitation protocol, and the 2-year minimum follow-up results of the operative treatment of recalcitrant patellar tendinopathy.
STUDY DESIGN
Retrospective case series.
METHODS
A retrospective review was performed of all patients who underwent a surgical primary patellar tendon debridement for recalcitrant patellar tendinopathy by a single surgeon between July 1999 and December 2005. Every patient failed at least 1 year of nonoperative treatment. Patients were excluded from the study if they had previous open knee surgery. Validated patient-reported outcome scores were used to assess function and pain levels pre- and postoperatively (Lysholm, International Knee Documentation Committee, Tegner activity, and visual analog pain score).
RESULTS
Thirty-four consecutive patients (37 consecutive cases) with mean follow-up 3.8 ± 1.6 years (range, 2-7.6 years) underwent the procedure with no complications. The mean age at surgery was 29 years (range, 14-51 years). Postoperatively, the visual analog score decreased by an mean of 6 points (range, 1 to -10, P < 0.001), and patients were able to return to their preinjury Tegner activity level. When asked if they were satisfied by the overall outcome of their surgery, 28 patients (82%) were completely or mostly satisfied with their surgical outcome on a particular knee; 6 (18%) were somewhat satisfied; and 2 (6%) were dissatisfied. Twenty-seven patients (79%) said they would have the surgery again.
CONCLUSION
The combined arthroscopic and open surgical technique described for chronic recalcitrant patellar tendinopathy successfully reduces knee pain and allows return to preinjury level of activity.
背景
对于至少经过 1 年非手术治疗且持续存在致残症状的患者，髌腱病可通过手术治疗。髌腱病可导致明显的功能缺陷，但有关髌腱病的手术治疗却鲜有报道。
假设
对于难治性髌腱病，采用关节镜联合开放手术治疗可改善功能和疼痛，且至少在 2 年随访时效果可维持。本研究旨在介绍难治性髌腱病的手术治疗适应证、联合手术技术、康复方案和 2 年的最低随访结果。
研究设计
回顾性病例系列研究。
方法
对 1999 年 7 月至 2005 年 12 月期间由同一位外科医生采用单一手术方式对难治性髌腱病进行初次髌腱清创术的所有患者进行回顾性分析。每位患者均至少经历了 1 年的非手术治疗失败。如果患者既往有膝关节开放性手术，则将其排除在研究之外。采用经过验证的患者报告结局评分（Lysholm、国际膝关节文献委员会、Tegner 活动度和视觉模拟疼痛评分）来评估术前和术后的功能和疼痛水平。
结果
34 例连续患者（37 例连续病例）接受了手术，平均随访 3.8 ± 1.6 年（范围，2-7.6 年），无并发症发生。手术时的平均年龄为 29 岁（范围，14-51 岁）。术后，视觉模拟评分平均降低 6 分（范围，1 至-10，P < 0.001），且患者能够恢复到受伤前的 Tegner 活动水平。当被问及对手术整体结果是否满意时，28 例（82%）患者对特定膝关节的手术结果完全或大部分满意；6 例（18%）患者有些满意；2 例（6%）患者不满意。27 例（79%）患者表示愿意再次接受手术。
结论
对于慢性难治性髌腱病，采用本文描述的关节镜联合开放手术技术可成功减轻膝关节疼痛，并使患者恢复到受伤前的活动水平。
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