The Investigation Of Curative Effect About The Triple Combined Operation Of Reform And The Triple Combined Operation Of Tradition For Curing Recurrent Dislocation Of Patella By Using The Arthroscopy

Purpose:Analyze the curative effect which is better between the triple combined operation of tradition (loosen the ectal retinaculum, tighten the inside retinaculum, cut the tibial tubercle for transferring to be a high and inside level)and the triple combined operation of reform (loosen the ectal retinaculum, reconstruct the inside medial patellofemoral ligament, cut the tibial tubercle for transferring to be a high and inside level)for curing the recurrent dislocation of patella by using the arthroscopy at present, to provide a meaningful reference for department of orthopedics doctors to choice method of operation.Methods:This investigation was a type of retrospective analysis in view of the data from the patient of our hospital, the object of investigation who were all suffered from the recurrent dislocation of patella and treated from March2011to August2013.They were all female and age12～23years old. The object of investigation were divided into two groups in accordance with the two different methods of combined operations:group A:The triple combined operation of tradition; group B:The triple combined operation of reform. All patients in peri operation period is handled in the same way:the same category of anaesthesia, the same category about antibiotics, the project of treatment about symptomatic, the same category of drug of postoperative nursing and make the same methods of functional exercise. The time was followed up for16.80months (9～29months) after operation.All the object of investigation all make the physical check before and after the operation routinely, also all the Q angle must be measured, and take an X-ray of knee joint and lateral patellar axial slices, and measure the patellofemoral fitness angle, after all, measure and calculation the patellofemoral indices. Use the Lysholm evaluation sheet and IKDC evaluation sheet to evaluate and compare patellofemoral joint function of recovery after operation(There are4grades in accordance with the score of outcome, the excellent grade is more than85points, the good grade is76-85,the qualified grade is60～75, the bad grade is below59). Application of SPSS system on the operation of two triple operation were analyzed after the comparison between two groups, the Q angle, patellofemoral fitness, patellofemoral index of test, use the SPSS17.0software test to compared with between two groups for excellent rate of these grade data by using rank sum test, If P<0.05,we can consider that the difference of compare results is significant statistically.Results:after28cases of36patients with knee surgery were followed up,36knees of the object of investigation all had not anymore pain、arthroncus and dislocation of patella when finished the two type of operations. patellofemoral stability improved obviously, patellar tracking is good, the data of statistics are as follow:Group A:Q angle (18.9±0.9); found X-ray contrast after operation, group A patellofemoral fitness from preoperative (8.22±1.44) to (5.76±1.23) degrees; patellofemoral index in group A from preoperative (0.79±1.1) to (0.56±0.09); Lysholm score:(73.6±7.3)%,10knees were excellent,3knees were good,5knees were qualified,0knee was bad., There were72.2percent of the the object of investigation whose knee joint function were evaluated excellent or good; the subjective evaluation of knee joint function IKDC:(76.9±3.1)%,11knees were excellent,3knees ware good,4knee ware qualified,0knees was bad, there were77.8 percent of the object of investigation whose knee joint function were evaluated excellent or good.Group B:Q:(16.9±0.9); found X-ray contrast after operation, group B of patellofemoral fitness from preoperative (8.37±1.16) to (4.96±0.63degrees); group B, patellofemoral indices from preoperatively to (0.82±0.08) to (0.63±0.07); the Lysholm score:(92.7±3.2)%,14knees were excellent,2knees ware good,2knees ware qualified,0knee was bad, there were88.9percent of the object of investigation whose knee joint function were evaluated excellent or good; the subjective evaluation of knee joint function IKDC:(93.3±3.2)%,15knees were excellent, good in2knees,1knees, difference0knees, there were94.4percent of the object of investigation whose knee joint function were evaluated excellent or good.The difference of compare results of Q angle、patellofemoral fitness angle and patellofemoral indices between group A and group B were significant statistically(p<0.05) in accordance with the compare of statistics. After comparing the excellent and good rate of the knee function by using the rank sum test, we consider that the excellent and good rate of group B was much better than group A, the difference of results is meaningful statistically.(p<0.05)Conclusion:1.The triple combined operation of reform and the triple combined operation of tradition all are effective for curing the recurrent dislocation of patella by using the arthroscopy.2. The curative effect of the triple combined operation of reform is much better than the triple combined operation of tradition for curing the recurrent dislocation of patella.3. The curative effect at a specified future date of these two triple combined operation of patella for prevent or postponing the patellofemoral degenerative changes happening must be made further efforts to validate.