高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂

Reinforcement of chronic patellar tendon repair with high strength polyester sutures

目的探讨陈旧性髌腱断裂的临床特点，介绍采用高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂的手术方法和术后康复方法。方法2002年1月至2007年2月，收治陈旧性髌腱断裂6例，手术切断超长的瘢痕愈合髌腱组织，恢复长度后重新吻合，并在胫骨结节和髌骨两端钻骨孔，采用4根高强度聚酯纤维缝线经骨孔减张保护。术后对患者采用积极的康复锻炼方案：术后第1天即可下地直立行走及被动屈膝90°，休息和睡眠时不须支具石膏固定保护；术后3周起开始练习主动抬腿；术后6周后开始练习快走，负重2kg直腿抬高；术后12周后开始练习上下楼梯和下蹲；术后6个月后开始正常运动以及蹬跳运动。结果术后随访1-5年，平均3.2年。患者早期即可以活动并可以下床直立行走，所有患者均未出现再断裂。手术6个月以后，患者均恢复正常的平地行走、跑步能力等，屈膝基本达到对侧的水平，股四头肌力量良好。Lysholm评分均能达到100分。结论高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂，创伤小，方法简单，不须外加牵引，不须石膏固定，不须二次手术取内固定，积极的康复训练允许患者早期行走，效果可靠。

Objective To summarize the clinical features of chronic ruptured patellar tendon, and introduce the augmentation technique of repair of chronic ruptured patellar tendon with high strength polyester sutures and postoperative rehabilitation. Methods Six cases of chronic patellar tendon rupture were treated and reinforced with high strength polyester sutures from 2002 to 2007. Patellar tendon ruptures was primary end-to-end repaired, and reinforced with 4 polyester sutures that were passed through intraosseous tunnels within the patella and tibial tubercle. The surgery reestablished knee extensor continuity and restored the length of patellar tendon. Augmentation techniques were reliable, and allowed patients to walk and bend the knee, regain adequate quadriceps strength early. Postoperative rehabilitation： on the 1st day after surgery, walking upright and passive flexion of 90° was allowed, and brace protection was unnecessary; 3 weeks later, straight leg raise; 6 weeks later, brisk walking; 12 weeks later, squatting and climbing stairs; 6 months later, sports was allowed, including the jump and kick. Results All patients were followed up from 1 to 5 years. No patient sustained a re-rupture. All patients satisfied with their result. The Lysholm score were 100. Each knee had restored full range of motion 6 months later, and regained adequate quadriceps strength. Conclusion Augmentation techniques with high strength polyester sutures is reliable and demonstrate good intermediate to long-term results. It can avoid re-operation for removal of the cerelage wire, allow patients to walk and bend the knee, regain adequate quadriceps strength early.