初次全膝关节置换术中内侧副韧带损伤的处理及随访研究  

Treatment and follow-up research of medial collateral ligament injury in the primary total knee arthroplasty

作　　者：张博[1] 王志为[1] 曲铁兵[2] 林源[1] 潘江[1] 任世祥[1] 陈彤[1] 温亮[1] 周磊[1] 马德思 赵潇雄 Zhang Bo;Wang Zhiwei;Qu Tiebing;Lin Yuan;Pan Jiang;Ren Shixiang;Chen Tong;Wen Liang;Zhou Lei;Ma Desi;Zhao Xiaoxiong(Orthopedic Department,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Joint Functional Reconstruction,China Rehabilitation Research Center,Beijing Boai Hospital,Capital Medical University,Beijing 100068,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]首都医科大学附属北京博爱医院关节病诊疗中心,北京100068

出　　处：《首都医科大学学报》2020年第4期603-607,共5页Journal of Capital Medical University

基　　金：北京市优秀人才培养资助青年骨干个人项目(2017000021469G230)。

摘　　要：目的回顾性研究初次全膝关节置换(total knee arthroplasty,TKA)术中内侧副韧带(medial collateral ligament,MCL)损伤患者的处理方法以及随访结果。方法选取2013年1月至2016年1月,在首都医科大学附属北京朝阳医院行初次全膝关节置换患者共612例(798膝),术中出现MCL损伤的患者共10例(10膝)。其中体部损伤患者7例,除1例采取同种异体肌腱加强固定以外,其余患者均采用了断端直接缝合的方法;股骨侧止点撕脱2例,采用双排锚钉桥样缝合进行止点重建;胫骨侧止点撕脱1例,采用单排带线锚钉重建止点的方法。所有MCL损伤的患者均未使用限制性假体,术后康复过程中佩戴下肢膝关节保护支具,出院后定期门诊随访,检查患者侧方应力情况,并记录手术前及最后一次随访时的美国膝关节协会评分(Knee Society Score,KSS)以及膝关节的活动度。结果患者术中出现MCL损伤的总发生率为1.2%(10/798,95%CI:0.5%~2.0%),10例MCL损伤的患者中无失访病例,随访时间25~62个月(中位随访时间46.5个月);门诊检查伸直位外翻应力均未见松弛,屈膝30°位有3例患者出现轻度松弛(+);患者KSS由术前的74.5分(52~96分)改善为术后的149.8分(124~172分);患者的膝关节活动度由术前的平均78.5°(65°~95°)改善为术后的105.5°(95°~120°),差异均有统计学意义(P<0.05);至最后一次随访无患者因为内侧松弛而进行膝关节翻修手术。结论对TKA术中出现MCL的损伤应该积极地进行修复,采用牢靠的固定方法可以避免术中更换限制性假体,降低术后因为内侧松弛而进行膝关节翻修的发生率。Objective To retrospectively study the treatment methods and follow-up results of the medial collateral ligament(MCL)injury in total knee arthroplasty(TKA)surgery.Methods From January 2013 to January 2016,612 cases(798 knees)has underwent primary TKA,10 cases(10 knees)of which suffered from MCL injury.Among them,7 patients were injured in the body of MCL,2 cases in the end point of the femoral,and 1 case in the end point of the tibial.All ten patients didn't use the restrictive prosthesis and did the postoperative rehabilitation with a leg braces.We s scheduled follow-up with the patients and checked lateral stress condition after the surgery.The Knee Society Score(KSS)and range of the motion before surgery and at the last follow-up were recorded.Results The total incidence of MCL injury in this group of patients was 1.2 percent(10/798,95%CI:0.5%-2.0%).The follow-up time was 25 to 62 months(mean 46.5 months),with no case lost to follow up.There was no relaxation when extending the knee in the outpatient examination.3 patients had mild relaxation(+)when bending the knees 30 degrees.The KSS of patients was improved from 74.5 points(52-96 points)before surgery to 149.8 points(124-172 points).The degree of activity of the knee joint was improved by an average of 78.5°(65°-95°)to 105.5°(95°-120°),with the difference statistically significant.During the last follow-up,no patients underwent knee repair due to the medial relaxation.Conclusions We should repair the MCL positively when it was injured during the surgery.Stable internal fixation can avoid replace the restrictive prosthesis and reduce the incidence of revision due to the medial unstable.

关 键 词：关节成形术 置换 膝 内侧副韧带 损伤 

分 类 号：R684[医药卫生—骨科学]