Schultz W, Buhmann H W, Leib S
Orthopädische Universitätsklinik Göttingen.
Sportverletz Sportschaden. 1996 Mar;10(1):13-8. doi: 10.1055/s-2007-993390.
The success rate of the operation of lateral release for pain caused by the patella is reported as being between 14% and 99%. The choice between arthroscopic or open procedures does not seem to affect the results. The wide ranges of results probably reflects differences in patients selection or the method and investigations of follow up. The early term outcome usually show better results than long term follow up. This study evaluates the indications for the operation of lateral releases and discusses the result of 36 out of a total of 42 patients who were follow up for 3 years later surgery. We found that an insufficiency of dysplasia of the vastus medialis, the laxity of the capsule and soft ligaments, and a strong lateral retinaculum were important factors in the indication for this procedure. The quadriceps angle was also of prime importance, but the minor forms of patellar dysplasia played only a minor role. In the so-called hyperpression syndrome, where the patella has a strong tendency to move laterally, the simple lateral release is the single most successful operation. The indication for procedures additionally to the lateral release is examined. We found that in a case with an insufficiently guided patella, a weak capsule and ligaments, an additional capsule roughing should be performed. The presence of early degenerative changes in the joint predisposes to poor results in operations such as abrasion and pride drilling. The results in our study were assessed using the Lysholm score. Our results show that the most successful technique was the combination of an arthroscopy and an extraarticular open operation controlled by arthroscopic means. This technique was not associated with major complications such as haemarthrosis and consecutive prolonged postoperative rehabilitation. Overall we achieved a rate of 83% of good or satisfactory results at more than 3 years using the indications and techniques described above.
据报道，髌骨外侧松解术治疗疼痛的成功率在14%至99%之间。关节镜手术或开放手术的选择似乎不影响治疗结果。结果差异较大可能反映了患者选择、随访方法和调查方面的不同。早期结果通常比长期随访结果更好。本研究评估了外侧松解术的手术指征，并讨论了42例患者中36例术后3年的随访结果。我们发现，股内侧肌发育不全、关节囊和软韧带松弛以及外侧支持带紧张是该手术指征的重要因素。股四头肌角也至关重要，但轻度髌骨发育异常仅起次要作用。在所谓的高压综合征中，髌骨有强烈的向外移位倾向，单纯外侧松解术是最成功的单一手术。本文还探讨了除外侧松解术之外的其他手术指征。我们发现，对于髌骨轨迹不良、关节囊和韧带薄弱的病例，应额外进行关节囊粗糙化处理。关节早期退变会使诸如磨削和钻孔等手术的效果不佳。我们的研究结果采用Lysholm评分进行评估。我们的结果表明，最成功的技术是关节镜检查与关节镜控制下的关节外开放手术相结合。该技术不会引发诸如关节积血和术后持续长时间康复等严重并发症。总体而言，使用上述指征和技术，我们在3年多的时间里取得了83%的良好或满意结果。
