采用自体胭绳肌腱重建膝关节多发韧带损伤

Reconstruction of multiple ligament injuries of the knee with autogenous hamstring tendons

目的探讨采用自体胭绳肌腱“人”字形加强修复膝关节内侧侧副韧带浅层（sMCL）和后斜韧带（POL）的新技术，分析其对膝关节内侧稳定的作用。方法2002年8月至2004年2月，采用自体胭绳肌腱“人”字形加强修复损伤的sMCL和POL治疗19例患者，患者均合并交叉韧带损伤且需手术重建，故有时需取健侧胭绳肌腱作为韧带重建结构。结果19例患者得到49～67个月（平均57个月）随访。根据国际膝关节文献委员会评分系统（IKDC），所有患者膝关节在0和30啦应力外翻试验时内侧稳定性完全恢复正常。术前膝关节Lysholm评分为（58．5±4．2）分（37～70分），终末随访时为（92．2±3．6）分（84．96分），差异有统计学意义（P〈0．05）。其中6例患者术后3个月因膝关节活动受限而接受手法松解。除2例患者主诉健侧膝关节内侧麻木外，所有健侧患肢在取胭绳肌腱后无功能受限。结论采用自体胭绳肌腱“人”字形增强修复损伤的sMCL和POL能有效恢复膝关节内侧稳定。

Objective To evaluate the results of a new surgical technique which augments the repair of superficial medial collateral ligament （sMCL） and posterior oblique ligament （POL）. Methods In our surgical procedure, the autogenous semitendinosus or gracilis tendon looped in shape was used to augment the repair of sMCL and POL. From February 2004 to August 2002, 21 patients with symptomatic medial instability underwent this surgical procedure. Most cases were complicated with cruciate ligament injuries, necessitating concomitant cruciate ligament reconstruction. In some cases, the hamstring tendon was harvested from the healthy side for the reconstruction. Results Of the 21 patients, 19 were evaluated after a mean follow-up period of 57 （range, 49-67） months. At follow-up, when valgus stress was applied to the knee at 0 and 30 degrees of flexion, their medial stability was graded as normal or nearly normal according to the International Knee Documentation Committee （IKDC） criteria. Their mean Lysholm score was 58.5 ± 4. 2 before surgery and 92.2 ± 3.6 at the last follow-up （ P 〈 0.05 ）. Six patients received manipulation for arthrofibrosis 3 months after operation. No patients complained of donor-side morbidity or disfunction of the healthy leg, except 2 cases who complained of numbness on the medial side. Conclusion It is reliable to augment the repair of sMCL and POL with autogenous hamstring tendons in shape, since it restores the medial stability of the knee.