全膝关节置换过程中内侧副韧带损伤的直接修复联合支具辅助治疗  

Direct repair of medial collateral ligament injury combined with brace in total knee arthroplasty

作　　者：刘坤[1] 徐浩[1] 王英振[1] 张海宁[1] 方源[1] 项帅 吕成昱[1] Liu Kun;Xu Hao;Wang Yingzhen;Zhang Haining;Fang Yuan;Xiang Shuai;LüChengyu(Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266100,Shandong Province,China)

机构地区：[1]青岛大学附属医院关节外科,山东省青岛市266100

出　　处：《中国组织工程研究》2021年第15期2352-2357,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节置换过程中内侧副韧带损伤是一种少见但严重的并发症,对于内侧副韧带损伤治疗方法的选择存在不同意见。目的:对于全膝关节置换术中的内侧副韧带损伤,评价局部缝合修复联合术后支具保护能否取得满意的临床结果。方法:回顾性分析2016年1月至2018年1月青岛大学附属医院关节外科收治的全膝关节置换术中发生医源性内侧副韧带损伤的患者14例(试验组),所有病例均采用局部缝合修复联合支具保护6周治疗;抽取110例同时期行全膝关节置换的内侧副韧带未损伤病例作为对照(对照组)。记录内侧副韧带损伤部位,分析损伤原因;对比两组术前、术后的膝关节活动度及美国膝关节协会评分。结果与结论:①术中内侧副韧带体部损伤12例,其中前束11例,后束1例,均为部分断裂;胫骨侧撕脱2例;②试验组和对照组术后膝关节活动度均较术前显著改善(P<0.05),两组术后2个月、1年膝关节活动度比较差异无显著性意义(P>0.05);③在最后一次随访时,试验组和对照组美国膝关节协会评分均较术前显著提高(P<0.05),但两组之间差异无显著性意义(P>0.05);④在初次全膝关节置换中内侧副韧带以前束和体部损伤为主,采取韧带直接修复联合术后支具保护6周治疗即可达到良好的修复效果,无需采用限制性假体、韧带重建等复杂手术处理。BACKGROUND:Medial collateral ligament injury in total knee arthroplasty is a rare but serious complication.There are different opinions on the treatment of medial collateral ligament injury.OBJECTIVE:To analyze the injury site of medial collateral ligament in primary total knee arthroplasty and evaluate the curative effect of local suture repair combined with brace protection and support after injury.METHODS:A retrospective analysis of 14 cases of iatrogenic medial collateral ligament injury during total knee arthroplasty in Department of Joint Surgery,Affiliated Hospital of Qingdao University from January 2016 to January 2018(trial group)was conducted.All cases were treated with local suture repair combined with brace protection for 6 weeks.110 cases without injury of medial collateral ligament in the same period were selected as controls(control group).The location of medial collateral ligament injury was recorded and the causes of injury were analyzed.Range of motion and American knee society knee score were compared between the two groups before and after operation.RESULTS AND CONCLUSION:(1)Totally 12 cases of medial collateral ligament injury,including 11 cases of anterior bundle and 1 case of posterior bundle,who experienced transverse injury;and 2 cases of tibial avulsion.(2)Range of motion of the knee joint in the trial group and the control group was significantly improved after operation compared with preoperation(P<0.05),and there was no significant difference between the two groups in range of motion at 2 months and 1 year after operation(P>0.05).(3)At the last follow-up,American knee society knee score was significantly higher in the trial and control groups compared with preoperation(P<0.05);however,there was no significant difference between the two groups(P>0.05).(4)In the first total knee arthroplasty,the injury of the anterior bundle and body of the medial collateral ligament was the main injury,and the direct repair of the ligament combined with the protection of the post-operative brace for 6

关 键 词：膝 关节 全膝关节置换 内侧副韧带 损伤 活动度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]