To Explore The Clinical Research Of Arthroscopic Surgery For Patellomalacia Based On The Theory Of "muscles And Bones"

Objective:Chondromalacia patellae is one of the common causes of knee pain.It is an early pathological change of patellofemoral osteoarthritis and a degenerative change of patellofemoral cartilage caused by injury.The disease is very common in clinical work and its pathological mechanism is fairly complicated.In recent years,scholars at home and abroad have done a lot of basic and clinical research on it.It is suggested that the biomechanical disorder of patellofemoral joint is the main cause,and that the medial cartilage of the patella impacts the trochlea of the lateral femoral condyle because of outward tilt or subluxation of patella during the motion of knee joint.Therefore,correcting the abnormal biomechanics line of patellofemoral joint has become the focus of treatment.Su Wen derived from Huang Di Nei Jing Su sayed,"All the tendons belong to joint "and" All the tendons restrain the bones and make the joints move smoothly.".Professor Shi Yinyu put forward the idea of "Bone is bound by tendons,which are connected with tendons".It can be seen that the tendons and bones are closely linked,and each of them is in its place.Through the "bundle" function of tendons,the balance relationship between the joint and its surrounding tissues is maintained,and various physiological activities are completed.We attempts to apply this theory to the treatment of chondromalacia patellae in this study.Soft tissue balance with lateral retinaculum release under arthroscope can achieve the balance of tendons and bones and restore the biomechanics of patellofemoral joint.Methods:Outpatients and inpatients meeting the inclusion criteria were randomly divided into experimental group and control group,30 cases in experimental group and 30cases in control group.The experimental group was treated with arthroscopy combined with routine functional exercise for the disease.The control group was treated with sodium hyaluronate joint puncture three times a week,combined with routine functional exercise.In this study,the data of sex,age,course of disease,pain visual analogue scale(VAS),Lysholm score,X-ray and MRI were collected.Patients were observed before treatment,one week,one month and six months after treatment.VAS and Lysholm observation scale were used to evaluate the symptoms and functions of knee joint.Among them,VAS score and Lysholm table were recorded by the third party before and after treatment.After treatment and follow-up,the data were processed by SPSS20.00 and Eccel statistical software,and then plotted by Origin 2017 software.Finally,the results were obtained.Results:1.The VAS scores of the experimental group and the control group before and after treatment were compared.The VAS scores of the experimental group decreased significantly with the prolongation of treatment time from different time points(before treatment,1 week after treatment,1 month after treatment and 6 months after treatment).The comparison of the VAS scores at different time points had statistical significance(F=8.649,P=0.032<0.05).Compared with the control group,the VAS score decreased gradually with the prolongation of treatment time from different time points(before treatment,1 week after treatment,1 month after treatment and 6 months after treatment),and the comparison at different time points had statistical significance(F=12.540,P=0.043).It showed that the pain symptoms of knee joint in both groups are obviously alleviated.There is no remarkable difference in VAS score between the both groups before treatment(t?1.408,P=0.165>0.05),suggesting that the two groups were comparable.But the VAS score of the experimental group was obviously lower than that of the control group at 1 week,1 month and 6 months after treatment(P<0.05),suggesting that the knee pain relief degree of the experimental group is evidently higher than that of the control group.2.Compared with Lysholm scores about before and after treatment,Lysholm scores in the experimental group increased clearly with time before treatment,1 week after treatment,1 month after treatment and 6 months after treatment.There was statistical significance at different time points that before treatment,1 week after treatment,1 month after treatment and 6 months after treatment in the experimental group(F=31.922,P?0.028<0.05).The treatment results at different time points were statistically significant in the control group(F=21.485,P=0.044).It shows that the knee joint function of both groups has been improved.Inter-group comparison:there was no clear difference in Lysholm score between groups before treatment(t?0.428,P?0.670>0.05),but the Lysholm score of the experimental group is sharply higher than that of the control group at 1 week,1 month and 6 months after treatment(P<0.05),suggesting that the functional recovery of knee joint in the experimental group is evdently better than that of the control group(P<0,05).3.The two groups of clinical efficacy evaluation,the total effective rate of treatment between groups is not very different,but from the clinical cure point of view,the cure rate of the experimental group is higher than that of the control group,indicating that the treatment effect of the experimental group is better and the curative effect is more prominent.Conclusion:1.Arthroscopic surgery and sodium hyaluronate arthroplasty can alleviate knee pain,but arthroscopic surgery has better pain relief than sodium hyaluronate arthroplasty at different time points after treatment.2.Arthroscopic surgery and sodium hyaluronate arthroplasty can improve knee joint function,but the knee joint function of patients after arthroscopic surgery is better than that of conventional sodium hyaluronate therapy.3.Clinical evaluation shows that the total effective rate of the two methods is higher,but the clinical effect of arthroscopic surgery for patellomalacia is better.4.In view of the theory of "tendonbundle bone",soft tissue balance surgery with lateral retinaculum release under arthroscope used to treat chondromalacia patellae can achieve the balance of fascia and bone and restore the biomechanical relationship of patellofemoral joint.It gets good clinical efficacy.