股二头肌长头腱等长重建膝关节外侧副韧带  

Isometric reconstruction of knee lateral collateral ligament with the long head of biceps femoris tendon

作　　者：石仕元[1] 郑琦[1] 魏威[1] 

机构地区：[1]浙江省中西医结合医院骨科,浙江杭州310003

出　　处：《中国骨伤》2009年第3期176-178,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过研究膝关节外侧副韧带在股骨髁上的等长点,采用股二头肌长头腱等长重建膝关节外侧副韧带,并探讨其临床结果。方法:自2001年6月至2007年6月,采用股二头肌长头腱等长重建外侧副韧带16例,男10例,女6例;年龄20～58岁,平均38.4岁。急性损伤4例,陈旧性损伤12例,病程5d～11个月。3例合并后十字韧带损伤,2例合并前十字韧带损伤,整组病例不包含其他后外侧结构损伤的病例。切取股二头肌长头肌腱的中1/3,固定在其股骨外髁的等长点上,通过膝关节内翻应力试验,判断膝关节外侧结构的稳定性。结果:外侧副韧带腓骨附着点或股二头肌长头肌腱的中1/3腓骨附着点至外侧副韧带股骨附着点的前方或前下方8～10mm处具有较好的等长性。术后随访12～24个月,平均13.5个月。术前稳定性检查,完全伸膝内翻不稳Ⅲ度7例,Ⅱ度9例;屈膝30°位,内翻不稳Ⅲ度9例,Ⅱ度7例。术后16例完全伸膝位均无内翻不稳;屈膝30°位,Ⅰ度内翻不稳2例,其内翻应力试验外侧关节间隙较健侧增大程度小于5mm。结论:应用股二头肌长头腱等长重建膝关节外侧副韧带能有效恢复膝关节外侧结构在屈伸过程中的稳定性,手术创伤相对较小,是一种理想的重建方法。Objective：To explore the isometric attachment site of knee lateral collateral ligament （LCL） in the femoral lateral condyle ;to introduce the isometric reconstruction of knee lateral collateral ligament with the long head of biceps femoris tendon. Methods：Among 16 patients with knee injury treated with isometric reconstruction of the lateral collateral ligament, 10 patients were male and 6 patients were female, with an average age of 38.4 years （ranged from 20 to 58 years）. Twelve patients were chronic injuries, four patients were acute injuries, with an average duration of 5 days to 11 months. Eleven patients had simple LCL injury, 3 patients had LCL injury combined with PCL injury, 2 patients had LCL injury combined with ACL injury. The middle one third of the long head of biceps femoris tendon was cut to be fixed to the isomeric bony tunnel of the femoral lateral condyle. The lateral stability of the knee was evaluated mainly through varus stress test. Results ：The better isometric attachment site is from the anatomical caput fibulae attachment site or the middle one third of the long head of biceps femoris to the femoral lateral condyle to 8-10 mm in front of the anatomical femoral attachment site of the lateral collateral ligament. The average follow-up period was 13.5 months （ranged from 12 to 24 months）. At the 12th month after operation, there was no varus instability in full extension. At 30° flexion, one-grade varus instability was found in 2 patients. In varus stress test the lateral joint space increased less than 5 mm compared to the healthy side. Conclusion： The method provided good stability for the knee and acquired satisfactory clinical results.

关 键 词：膝关节 重建外科手术 韧带 关节 创伤和损伤 

分 类 号：R687.4[医药卫生—骨科学] R684[医药卫生—外科学]