异体肌腱修复重建164例肌腱韧带损伤的临床分析  

CLINICAL ANALYSIS OF TREATING 164 CASES OF TENDON AND LIGAMENT INJURIES WITH ALLOGRAFT TENDON

作　　者：郑小飞[1] 黄华扬[1] 尹庆水[1] 丁焕文[1] 符史发[1] 章莹[1] 

机构地区：[1]广州军区广州总医院骨科,广州510010

出　　处：《中国修复重建外科杂志》2009年第6期666-669,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结异体肌腱修复重建肌腱韧带损伤的手术方法及临床疗效。方法2000年9月-2007年5月,收治164例肌腱韧带损伤患者。男116例,女48例;年龄21～47岁,平均31.5岁。前交叉韧带损伤126例,完全性肩锁关节脱位18例,桡骨小头陈旧性脱位10例,跟腱断裂4例,胫前肌断裂、髌腱断裂及股直肌断裂各2例。受伤至入院时间为4～345d,平均75d。术中采用长为10～26cm的异体肌腱联合缝线锚钉或可吸收界面挤压螺钉行肌腱韧带重建。结果术后切口除1例股直肌断裂者延期愈合外,其余患者均Ⅰ期愈合。164例均获随访,随访时间10～36个月,平均21个月。前交叉韧带损伤者术后12个月根据国际膝关节文献委员会评级及Lysholm评分与术前比较,差异均有统计学意义(P<0.01)。完全性肩锁关节脱位者术后10～12个月根据Lazzcano和Karlsson评分标准,获优13例,良5例。跟腱断裂者术后8～16个月根据Arner Lindholm评分标准优3例,良1例。胫前肌断裂者术后10～17个月踝关节背伸5°受限,胫前肌肌力减弱。1例髌腱断裂者术后14个月恢复膝关节活动范围,1例术后13个月膝关节伸直10°受限。股直肌断裂者1例术后18个月膝关节伸直15°受限,1例术后12个月伸直与屈膝均受限。桡骨小头陈旧性脱位者术后3～36个月Broberg-Morrey评分标准评估优7例,良3例。结论异体肌腱是修复重建肌腱韧带损伤的良好材料,但需注意术后适当保护下早期活动和及时处理局部排斥反应。Objective To research the operative method and the clinical efficacy of repairing and reconstructing tendon and ligament with allograft tendon. Methods From September 2000 to May 2007, 164 cases with tendon and ligament injuries were treated, including 116 males and 48 females aged 21-47 years old （average 31.5 years old）. There were 126 cases of anterior cruciate ligament injury, 18 cases of complete acromioclavicular dislocation, 10 cases of old dislocation of radial head, 4 cases of Achilles tendon rupture, 2 cases of tibialis anterior muscle rupture, 2 cases of patellar tendon rupture, and 2 cases of rectus femoris rupture. Time interval between injury and hospital admission was 4-345 days （average 75 days）. AUograft tendon 10-26 cm in length with suture anchor or absorbable interference screw was used to reconstruct the ligament and tendon. Results All wounds healed by first intention, except one case of rectus femoris rupture. All patients were followed for 10-36 months （average 21 months）. The international knee documentation commitee and the Lysholm score of patients with anterior cruciate ligament injury 12 months after operation were significantly higher than that of before operation （P 〈 0.01）. According to the Lazzcano and Karlsson score standard, 13 cases of complete acromioclavicular dislocation at 10-12 months after operation were graded as excellent and 5 cases were good. According to Arner Lindholm score standard, 3 cases of Achilles tendon rupture at 8-16 months after operation were graded as excellent and 1 case was good. For the patients with tibialis anterior muscle rupture, at 10-17 months after operation, the limitation of dorsal extension in ankle joint was 5°, and the muscle strength in the anterior tibialis muscle was decreased. For the patients with patellar tendon rupture, one completely restored the motion range of the knee joint 14 months after operation, the other had knee extension limitation of 10° at 13 months after operation. For the patients with rectus femo

关 键 词：异体肌腱 肌腱损伤 韧带损伤 修复重建 

分 类 号：R687.2[医药卫生—骨科学]