摘要
目的 探讨异体肌腱解剖重建治疗膝内侧副韧带陈旧性损伤的临床效果.方法 2007年3月至2012年2月,收治64 例膝内侧副韧带陈旧性损伤患者.男44 例,女20 例;年龄20～46 岁,平均36 岁.所有病例外翻试验在膝关节伸直0°及屈膝30°位均呈阳性.双膝伸直位外翻应力位X线片示：双膝内侧关节间隙差3～5 mm 8 例,5～10 mm 52 例,大于10 mm 4 例.MRI示内侧副韧带均有损伤的影像学表现,T2相上可见高信号.受伤至入院时间为3～12个月,平均5.8个月.将患者按损伤程度平均分为两组,其中甲组32 例患者采用异体半腱肌腱仅重建内侧副韧带浅层前纵束结构,乙组32 例患者采用异体半腱肌腱解剖重建浅层及后斜韧带,均采用可吸收挤压螺钉固定.结果 术后切口除1 例外均Ⅰ期愈合,64 例均获随防,随访时间12～58个月,平均30个月.末次随访时根据改良Lysholm-Scale评分标准,甲组优16 例,良10 例,可6 例,优良率为81.25%,乙组优20 例,良11 例,可1 例,优良率为96.88%,均较术前明显改善,两组比较乙组优于甲组,差异有统计学意义.结论 使用异体肌腱解剖膝关节内侧副韧带陈旧损伤,重建全面可靠,易于操作,较单纯重建浅层结构临床效果良好.
Abstract： Objective To observe the effect of tendon allograft in the treatment of old knee medial collateral ligament in- jury. Methods Between March 2007 and Fabruary 2012,64 cases of old knee medial collateral ligament injury were treated, including 44 males and 20 females with a mean age of 36 years （range,20 - 46 years）. There were left knee injury in 36 cases and right knee in injury 28 cases. All patients showed the positive result of knee valgus test both in 0°and 30° position. The knee X-ray films of valgus stress position showed that the medial joint space differences between both knees were 3 - 5 mm in 8 cases,5 - 10 mm in 52 cases,above 10 mm in 4 cases. Apparent knee medial collateral ligament injury appearance could be observed in MRI films including high signal on T2WI. The time from injury to hospitalization was 3 - 12 months （mean,5.8 months）. All patients were divided into two groups. Tendon allograft was used to reconstruct only former longitudinal pat of knee medial collateral ligament in first group and to reconstruct anatomically in second group, the tendon was fixed in bone with absorbable screws in every operation. Results All incisions healed by first intention except one. Sixty-four cases were followed up 12 ~ 58 months with an average of 30 months. According to the modified Lysholm-Scale score, the results were excellent in 16 cases,good in 10 cases,and fair in 6 case with an good rate of 81.25% in first group,while excellent in 20 cases,good in 11 cases,and fair in 1 case with an excellent rate of 96.88% in second group at last follow up. The second group gets more better outcome than first group statistically. Conclusion All patients get good treatment effect with tendon allograft. But pa- tients with anatomical reconstruction achieves better effect than those only with former superficial layer reconstruction of knee medial collateral ligament.
出处
《实用骨科杂志》
2014年第2期123-126,共4页
Journal of Practical Orthopaedics
关键词
膝内侧副韧带
陈旧性损伤
异体肌腱
解剖重建
Key words：knee medial collateral ligament
old injury
tendon allograft
anatomical reconstruction
