改良自体腘绳肌腱重建髌韧带技术治疗陈旧性髌韧带损伤伴缺损的临床疗效  

Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects

作　　者：毛云鹤 孙伟豪 熊燕[1] 李棋[1] 陈刚[1] 唐新[1] 付维力[1] 李箭[1] MAO Yunhe;SUN Weihao;XIONG Yan;LI Qi;CHEN Gang;TANG Xin;FU Weili;LI Jian(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2021年第2期160-165,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用改良自体腘绳肌腱重建髌韧带治疗陈旧性髌韧带损伤伴缺损的临床疗效。方法回顾分析2015年1月—2018年8月采用髌骨1/2及下3/4双骨隧道和胫骨结节后方单骨隧道自体腘绳肌腱倒U形环绕法重建髌韧带治疗的11例陈旧性髌韧带损伤伴缺损患者临床资料。其中男8例,女3例;年龄10~61岁,平均30.1岁。初次受伤至手术时间2~36个月,平均9.5个月。髌韧带损伤按Yousef分型标准,A2型7例、B2型3例、C2型1例。术中测量髌骨复位时髌韧带缺损长度为2.7~7.1 cm,平均4.5 cm。术前及末次随访时行主观功能评分[包括国际膝关节文献委员会(IKDC)主观评分、Tegner活动评级、Lysholm评分],计算伸膝丢失角度、Caton指数以及健、患侧髌骨上极以上15 cm处的大腿周径差。结果11例患者均获随访,随访时间24~66个月,平均34.2个月。术后切口均达Ⅰ期愈合,未出现切口感染、下肢静脉血栓形成、膝关节僵硬、移植物失效、神经血管损伤等并发症;随访期间均未行二次翻修手术。末次随访时,主观功能评分(IKDC主观评分、Tenger活动评级、Lysholm评分)、伸膝丢失角度、大腿周径差及Caton指数均较术前显著改善,差异有统计学意义(P<0.05)。有2例患者仍存在高位髌骨,Caton指数分别为1.29和1.32。结论采用改良自体腘绳肌腱重建髌韧带技术治疗陈旧性髌韧带损伤伴缺损,能显著改善患者术后膝关节功能,恢复正常伸膝活动范围,提升伸膝肌力并纠正高位髌骨。Objective To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects.Methods The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed.The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts,in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella,and 1 bone tunnel was created beneath the tibial tuberosity.There were 8 males and 3 females with an average age of 30.1 years(range,10-61 years).The average interval from the primary injury to the operation was 9.5 months(range,2-36 months).According to Yousef classification,there were 7 cases of type A2,3 cases of type B2,and 1 case of type C2.The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm(range,2.7-7.1 cm).Subjective function scores[including International Knee Documentation Committee(IKDC)subjective score,Tegner activity level,and Lysholm score]were evaluated before operation and at last follow-up.The loss of knee extension,Caton index,and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured.Results All patients were followed up 24-66 months(mean,34.2 months).All incisions were primary healing,and there were no complications such as wound infection,venous thrombosis of the lower extremities,stiffness of the knee joint,graft failure,neurovascular injury,etc.No second revision surgery was performed during the follow-up.At last follow-up,the subjective function scores(IKDC subjective score,Tegner activity level,Lysholm score),loss of knee extension,thigh circumference difference,and Caton index were significantly improved when compared with those before operation(P<0.05).Two patients still had patella alta,with Caton indexes of 1.29 and 1.32,respectively.Conclusion In t

关 键 词：陈旧性髌韧带损伤 髌韧带重建 自体腘绳肌腱 高位髌骨 

分 类 号：R687.3[医药卫生—骨科学]