双束异体韧带三角形矢量重建内侧副韧带的临床研究  

Functional reconstruction of the medial collateral ligament with double-bundle allograft technique

作　　者：董江涛[1] 王飞[1] 陈百成[1] 宋矿朋[1] 纪刚[1] 马龙飞[1] 

机构地区：[1]河北医科大学第三医院关节外科,石家庄050051

出　　处：《中华外科杂志》2011年第12期1114-1118,共5页Chinese Journal of Surgery

摘　　要：目的探讨异体韧带双束重建膝关节内侧副韧带的手术方法，并经随访观察其临床疗效。方法以2007年6月至2010年3月收治的53例慢性膝关节内侧副韧带损伤的患者为研究对象，术前应力位X线片检查示膝关节内侧间隙较对侧增宽，且增宽间隙〉5mm，MRI检查示内侧副韧带连续性中断，外翻应力试验阳性，对所有患者行内侧副韧带重建手术。手术方法为股骨内侧髁至关节线下方5cm行纵行切口，于胫骨前内侧关节线下方4．5cm至后内侧关节线下方2cm斜向钻取直径5mm（或）6mm骨隧道，股骨内侧髁由内向外导针定位并沿导针钻直径6mm（或）7mm，长2．5～3．0cm的骨隧道，将异体肌腱两端编织后绕过胫骨隧道导入股骨隧道并用可吸收界面螺钉固定，使重建韧带呈三角形状。术后积极康复功能锻炼。术后1年应用Lyshlom评分、国际膝关节文献委员会膝关节评估表（IKDC）评价临床效果；外翻应力位X线片评估关节稳定性。结果所有患者术后Lyshlom评分（89．7±3．4）、IKDC评分[A或B评分46例（86．79％）]较术前（Lyshlom评分51．8±4．9，t=-79．724，P〈0．05；IKDC评分A或B者0例）均有明显改善．外翻应力位X线片测量内侧关节增宽间隙由术前（10．4±2．4）mm减小到术后（2．8±1．5）mm，差异有统计学意义（t=41．727，P〈0．05）；其中46例患者≤3mm，7例患者3—5mm。术前关节活动度135．4°±2．5°，与术后（132．7°±3．7°）比较差异无统计学意义。9例患者术后1年有不同程度的膝内侧局限性疼痛且存在明显压痛点。结论应用异体肌腱双束三角形重建内侧副韧带能明显改善膝关节内侧稳定性，短期临床疗效确定。Objective To discuss a new technique about reconstruction of medial collateral ligament （MCL） with double bundle allograft and to evaluate the short-term clinical efficacy. Methods All 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 ram compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lyshlom score were used to evaluate the clinical effect. Results The IKDC score （ A or B, 86. 78% vs. 0）, Lyshlom scores （ 89.7 ± 3.4 vs. 51.8 ± 4. 9, t = - 79. 724, P 〈 0. 05 ） were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from （ 10.4 ± 2.4） mm preoperative to （2. 8 ± 1.5） mm postoperative from X ray and the differences were significant （ t = 41. 727, P 〈 0. 05）. Among these patients, the medial joint widened gap of 46 cases were less than 3 ram, 7 cases were from 3 mm to 5 mm. Th

关 键 词：内侧副韧带 膝 移植 同种 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]