锚钉修复联合半腱肌转移治疗陈旧性髌腱断裂  

Anchor suture repairing combined semitendinosus tendon transfer for old patellar tendon rupture

作　　者：高东 郑江[2] 张宪[2] 康鑫[2] 任博[2] 赵赞栋 张红[2] 张亮[2] GAO Dong;ZHENG Jiang;ZHANG Xian;KANG Xin;REN Bo;ZHAO Zan-dong;ZHANG Hong;ZHANG Liang(The Department of Orthopedics,The Second Hospital of Yulin,Yulin 719000,China;Honghui Hospital,Xian Jiaotong University,Xian 710054,China)

机构地区：[1]榆林市第二医院,陕西榆林719000 [2]西安交通大学医学院附属红会医院,西安710054

出　　处：《中国矫形外科杂志》2020年第20期1893-1896,共4页Orthopedic Journal of China

基　　金：陕西省体局常规课题项目(编号:2018054)。

摘　　要：[目的]介绍锚钉修复联合半腱肌转移重建陈旧性髌腱断裂的手术技术与初步临床疗效。[方法]对8例陈旧性髌腱断裂的患者行锚钉修复联合保留止点的半腱肌移位重建髌腱。术中显露髌腱,松解伸肌装置,至髌骨可下降至正常水平位置。取半腱肌腱并保留其胫骨止点,分别于髌骨和胫骨结节建立横行骨隧道。将髌骨复位至正常水平位置,对原髌腱撕裂处用锚钉缝合,再将半腱肌腱游离端穿过髌骨和胫骨结节骨隧道,呈环形重建增强髌韧带。[结果]8例患者均顺利手术,术中无隧道骨折和血管、神经损伤等严重并发症。随访28~72个月,平均(43.25±13.47)个月,末次随访时IKDC、Lysholm和Tegner评分均较术前显著增加(P<0.05),所有患者均未再发生髌腱断裂。影像方面,Caton指数由术前(1.49±0.22)减少至末次随访时(1.13±0.07),差异有统计学意义(P<0.05)。[结论]锚钉止点修复联合保留止点的半腱肌重建方法治疗陈旧性髌腱断裂临床疗效可靠。[Objective]To introduce surgical technique and primary clinical outcomes of anchor suture repairing combined semitendinosus tendon transfer for old patellar tendon rupture.[Methods]Eight patients underwent anchor suture repairing combined semitendinosus tendon transfer for old patellar tendon rupture.After exposure,the knee extensor mechanism was released to reduce the patella downward to the normal level.The semitendinosus tendon was harvest with the tibial insertion intact,and transvers bone tunnels on the low third of the patella and the tibial tuberosity were created.As the patella reduced to the normal level,the original tear of the patellar tendon was repaired by anchor suture,and then the free end of semitendinosus tendon was introduced through the patellar tunnel and tibial tunnel to reconstruct and enhance the patellar tendon circumferentially.[Results]All the 8 patients had surgical procedure performed smoothly without serious complications,such as tunnel fractures,injuries to the major blood vessels or nerves.The patients were followed up for 28 to 72 months with a mean of(43.25±13.47)months.The IKDC,Lysholm and Tegner scores significantly increased at the latest follow-up compared with those before operation(P<0.05).However,no re-rupture of the repaired patellar tendon occurred in anyone of the 8 patients to the latest followup.In term of radiographic assessment,the Caton index significantly decreased from(1.49±0.22)before operation to(1.13±0.07)at the latest follow-up,which proved of statistical significance(P<0.05).[Conclusion]This anchor suture repairing combined semitendinosus tendon transfer is an effective,reliable and safe treatment for old patellar tendon rupture.

关 键 词：髌腱断裂 慢性损伤 重建 半腱肌腱移位 

分 类 号：R687[医药卫生—骨科学]