同种异体跟腱胫骨Inlay技术重建膝关节内侧副韧带的疗效观察  

TIBIAL Inlay RECONSTRUCTION OF MEDIAL COLLATERAL LIGAMENT USING Achilles ALLOGRAFT

作　　者：张杭州[1] 白希壮[1] 王琳[2] 孙羽[1] 

机构地区：[1]中国医科大学附属第一医院运动医学科与关节外科,沈阳110001 [2]中国医科大学附属第四医院骨科

出　　处：《中国修复重建外科杂志》2014年第2期223-226,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用同种异体跟腱胫骨Inlay技术重建膝关节内侧副韧带(medial collateral ligament,MCL)的临床疗效。方法回顾分析2011年1月-2012年12月,采用同种异体跟腱胫骨Inlay技术重建MCL的21例MCL损伤患者临床资料。男13例,女8例;年龄19~62岁,平均32岁。致伤原因:运动伤15例,交通事故伤6例。病程15 d^3个月,平均1.5个月。按照国际膝关节文献委员会(IKDC)2000的MCL损伤程度分度标准,Ⅱ度5例,Ⅲ度16例。膝关节外翻应力试验均为阳性。术后记录并发症发生情况,采用Lysholm评分、IKDC 2000主观评分评价膝关节功能。结果术中发生同种异体跟腱骨块碎裂1例。术后1例切口未愈合,经植皮修复后愈合;余20例切口均Ⅰ期愈合。无膝关节僵直、血管及神经损伤、膝关节感染等并发症发生。患者均获随访,随访时间7~29个月,平均18.5个月。末次随访时,膝关节外翻应力试验阴性20例,Ⅰ度阳性1例。除1例屈膝受限15°外,余均无伸、屈膝受限。膝关节Lysholm评分从术前(45.4±13.6)分提高至末次随访的(87.5±9.4)分,IKDC 2000主观评分从术前的(46.5±14.0)分提高至末次随访的(88.4±9.3)分,比较差异均有统计学意义(P<0.05)。复查MRI示移植物连续性良好。结论同种异体跟腱胫骨Inlay技术重建MCL后膝关节稳定性恢复良好,近期疗效满意,远期疗效有待进一步观察明确。Objective To evaluate the clinical results of the tibial Inlay technique for the medial collateral ligament （MCL） reconstruction using Achilles tendon allograft in recovery of medial instability of the knee. Methods Between January 2011 and December 2012, 21 patients underwent tibial Inlay reconstruction of the MCL using Achilles tendon allograft, and the clinical data were retrospectively analyzed. There were 13 males and 8 females with a mean age of 32 years （range, 19-62 years）. Injury was caused by sports in 15 cases and by traffic accident in 6 cases. The disease duration ranged from 15 days to 3 months （mean, 1.5 months）. According to International Knee Documentation Committee （IKDC） criteria, 5 cases were classified as degree II and 16 cases as degree III. The results of the valgus stress test were positive in all patients. The complications were observed after operation; IKDC subjective knee score and Lysholm score were used to assess the knee function. Results Bone block fracture occurred in 1 case during operation. Primary healing of incision was obtained in the other cases except 1 case having unhealing incision who was healed after skin grafting. No complications of knee joint stiffness, vascular nerve injury, and infection occurred. All patients were followed up 7-29 months （mean, 18.5 months）. At last follow-up, the results of the valgus stress test were negative in 20 cases, and positive （degree I） in 1 case; the other patients had no knee extension or flexion limitation except 1 patient having 15° flexion limitation. The Lysholm score was significantly improved from 45.± 13.6 to 87.5± 9.4, the IKDC 2000 subjective score was significantly improved from 46.5± 14.0 to 88.4 ± 9.3 at last follow-up （P 〈 0.05）. MRI showed that the reconstructed MCL was continuous. Conclusion The short-term clinical results of the tibial Inlay technique for MCL reconstruction using Achilles tendon allograft are satisfactory. The Inlay technique for MCL reconstruction can provide good me

关 键 词：内侧副韧带损伤 胫骨Inlay技术 同种异体跟腱 解剖重建 

分 类 号：R687[医药卫生—骨科学]