缝匠肌在股四头肌成形术中的应用

APPLICATION OF SARTORIUS MUSCLE IN THE QUADRICEPSPLASTY

目的 探讨解决部分伸直型膝关节僵硬,在股四头肌成形术后遗留伸膝无力,站立不稳,易跪倒等并发症。方法 1978 年～1997 年,在股四头肌成形术原切口上进行延长,游离缝匠肌,其止点不切断,移至髌骨前固定,加强伸膝装置力量,术后即刻进行膝关节被动、主动伸屈功能锻炼。结果 手术12 例,随访到9 例,随访时间9～25 个月,平均随访14个月。关节平均活动度,由术前15°增至102°,伸膝平均肌力,由术前Ⅱ级增至Ⅳ级。结论 缝匠肌前移手术加强了伸膝装置的力量,可解决膝关节伸直型僵硬、股四头肌成形术中伸膝肌力减弱。

Objective Extension stiffness of knee joint is always treated by the quadricepsplasty,but the main deficiency of this method is that patient feels weakness of lower limb and easily kneels down.The aim of this article is to explore the method to resolve the complications after quadricepsplasty.Methods Since 1978 to 1997,on the basis of traditional procedures of quadricepsplasty,sartorius muscle was used to reinforce the extension of knee joint.The lower 2/3 of sartorius muscle was fully dissociated only with its insertion intact.A tendon periosteal bone flap,about 2cm in width,was managed on the anterior surface of patella,with its pedicle on the medial edge of patella.The tendon periosteal bone flap was used to fix the dissociated sartorious into patella to reinforce the extension of knee joint.The very lower part of sartorius was mainly aponeurosis,with the help of an aponeurosis bundle of iliotibial tract,it was fixed into the insertion of patellar ligament,through a bony tunnel chiseled adjacent to the insertion of patellar ligament.By now the movement of knee joint extension was strengthened by the transferred sartorius muscle.Postoperatively, every patient was required to extend and flex knee joint actively and/or passively.Altogether 12 patients were treated,9 of them were followed up with an average of 14 months.Results The average movement was increased from 15° to 102°,and the average myodynamia was improved from grade Ⅱto grade Ⅳ.Conclusion Traditional quadricepsplasty co operated with transfer of sartorius muscle can strengthen the myodynamia of knee joint extension.It is simple method and can really achieve good function.