摘要
目的观察改良V-Y翻转肌腱瓣修复膝关节置换术后股四头肌肌腱断裂的临床疗效。方法 2005年至2010年,应用改良V-Y翻转肌腱瓣方法修复全膝关节置换术后股四头肌肌腱完全性断裂共12例患者,男4例,女8例;年龄45～77岁,平均62岁。术中通过切取全层肌腱瓣,松解股内、外侧肌远侧1/3,并将两侧肌肉缝合在一起,恢复股四头肌的完整性。术后采用膝关节评分标准评估患者功能恢复情况。结果所有患者均获得随访,随访时间12-54个月,平均24个月。术前所有患者行走需要助行器或轮椅帮助,术后则均可行走,无需协助。10例为优秀,2例良好。末次随访时,美国特种外科医院(the hospital for special surgery,HSS)膝关节评分为75～100分,平均为90分。股四头肌肌力平均为4/5级(3～5/5级),关节活动度为0。～120。。术后无患者发生肌腱二次断裂和感染。结论全膝关节置换后股四头肌肌腱断裂的治疗具有挑战性,改良V-Y翻转肌腱瓣是一种有效、可靠的手术修复方法。
Objective To evaluate the clinical results of a modified V-Y turndown flap reconstruction technique for the treatment of ruptured quadriceps tendon after total knee arthroplasty. Methods From 2005 to 2010, 12 patients who had a quadriceps tendon rupture after total knee arthroplasty were treated with a modified V-Y turndown flap reconstruction at our institution. Among them, there were 4 males and 8 females, whose average age was 62 years old （range; 45-77 years）. The modification involved harvesting the quadriceps tendon as a full thickness flap. The vastus medialis and lateralis muscles were released 1/3 distally and then sutured together to reinforce the repair without wires during the surgery. Postoperatively patients were evaluated with the knee joint surgery standard. Results All patients were followed up for a mean period of 24 months （range; 12-54 months）. Preoperatively all patients needed to use walking aid instrument or wheelchair in walk training, and while they could walk without aid postoperatively. 10 patients had excellent results and 2 had good results. In the latest follow-up, the mean Hospital for Special Surgery （HSS） knee score was 90 points （range; 75-100 points）. The mean quadriceps muscle force was grade 4/5 （range; grade 3-5/5）, and the range of motion was 0°-120°. There were no re-ruptures or infections postoperatively. Conclusions Rupture of the quadriceps tendon after total knee arthroplasty is a challenging problem, and the modified V-Y turndown flap technique provides an effective and reliable option for the reconstruction of ruptured quadriceos tendon.
出处
《中国骨与关节杂志》
CAS
2013年第1期20-24,共5页
Chinese Journal of Bone and Joint
