Yang Y P, Chen H Y, Zhao J W, Li N, Cui G Q, Ao Y F
Department of Sports Medicine,Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries,Beijing 100191,China.
Peking University Health Science Center,Beijing 100191,China.
Zhonghua Wai Ke Za Zhi. 2021 Sep 1;59(9):760-766. doi: 10.3760/cma.j.cn112139-20201229-00889.
To compare the clinical effects of arthroscopic lateral retinacular proximal release and "L" type release for lateral patellar compression syndrome. Sixty four lateral patellar compression syndrome (LPCS) patients were recruited who had arthroscopic surgery during September 2004 to January 2019 at Department of Sports Medicine,Peking University Third Hospital by the same group of doctors and a retrospective comparative study was conducted accordingly. Among them,24 cases underwent the traditional proximal release of lateral patellar retinaculum (traditional group),including 7 males and 17 females with an age of (42.9±14.6)years(range:23 to 72 years); 40 cases were treated with novel lateral retinacular release of "L" type release revised based on the previous experiences (novel group), consisting of 12 males and 28 females with an age of (54.9±13.1) years (range:28 to 76 years).All the patients participated surveys for the visual analogue scale (VAS),Lysholm score and International Knee Documentation Committee (IKDC) knee function subjective evaluation before and after the operation. The comparison of scores within groups was performed by Wilcoxon test,and comparison between groups was performed by Mann-Whitney test and Chi-square test. Multivariate analysis was used to evaluate the related factors affecting each score. The follow-up durations of traditional group and novel group were (12.6±1.0) years (range:11.7 to 15.3 years) and (2.2±1.0)years(range:1.0 to 4.4 years) respectively. At the last follow-up,VAS(0(1.0)to 6.0(2.0),=-5.471,<0.01),Lysholm score(98.0(10.0)to 48.0(40.0),=-5.511,<0.01),and IKDC score(82.8(11.2)to 37.4(18.5),=-5.444,<0.01) in novel group were statistically significantly improved,and the postoperative excellent rate of Lysholm score was 97.5% in general. There was no significant difference in the changes of the three scores (>0.05) between the traditional group and the novel group. However,20.8% (5/24)patients in the traditional group reported significant weakness of the knee extension after surgery,while no such complain was received in the novel group (<0.01).The results of univariate analysis showed that surgical method was a related factor affecting the changes of VAS before and after surgery (<0.05).The results of multivariate analysis showed that whether or not with osteoarthritis and operation type were independent factors affecting the changes of Lysholm and IKDC scores (<0.05). The long-term effect of arthroscopic lateral retinacular release for the treatment of LPCS is satisfactory. Compared with the traditional proximal release surgery,the "L" type release can effectively avoid the complication of significant weakness of the knee extension significantly.
比较关节镜下外侧支持带近端松解术与“L”型松解术治疗髌外侧挤压综合征的临床效果。选取2004年9月至2019年1月在北京大学第三医院运动医学科接受关节镜手术的64例髌外侧挤压综合征（LPCS）患者，由同一组医生进行回顾性对照研究。其中，24例行传统外侧髌支持带近端松解术（传统组），男7例，女17例，年龄（42.9±14.6）岁（范围：23至72岁）；40例行基于既往经验改良的新型外侧支持带“L”型松解术（新型组），男12例，女28例，年龄（54.9±13.1）岁（范围：28至76岁）。所有患者在手术前后均参与视觉模拟评分（VAS）、Lysholm评分及国际膝关节文献委员会（IKDC）膝关节功能主观评价调查。组内评分比较采用Wilcoxon检验，组间比较采用Mann-Whitney检验和卡方检验。采用多因素分析评估影响各评分的相关因素。传统组和新型组的随访时间分别为（12.6±1.0）年（范围：11.7至15.3年）和（2.2±1.0）年（范围：1.0至4.4年）。末次随访时，新型组VAS评分（从0（1.0）至6.0（2.0），Z=-5.471，P<0.01）、Lysholm评分（从98.0（10.0）至48.0（40.0），Z=-5.511，P<0.01）及IKDC评分（从82.8（11.2）至37.4（18.5），Z=-5.444，P<0.01）均有统计学意义的改善，Lysholm评分术后总体优良率为97.5%。传统组与新型组三项评分的变化差异无统计学意义（P>0.05）。然而，传统组20.8%（5/24）的患者术后出现明显的膝关节伸直无力，而新型组未收到此类主诉（P<0.01）。单因素分析结果显示，手术方式是影响术后VAS评分变化的相关因素（P<0.05）。多因素分析结果显示，是否合并骨关节炎及手术方式是影响Lysholm和IKDC评分变化的独立因素（P<0.05）。关节镜下外侧支持带松解术治疗LPCS的长期效果满意。与传统近端松解术相比，“L”型松解术能有效避免明显的膝关节伸直无力并发症。
