自体肌腱动静力结合重建陈旧性膝关节内侧副韧带断裂

The reconstruction of old medial collateral ligament injury by motive and statics method with autograft tendons

目的观察自体半腱肌、缝匠肌动静力结合法重建陈旧性膝关节内侧副韧带断裂的效果。方法对20例陈旧性膝关节内侧副韧带断裂患者先行膝关节镜检查,合并外侧半月板损伤10例,行半月板部分切除术,合并前交叉韧带损伤6例,选择骨-髌腱-骨重建前交叉韧带,于鹅足肌腱部位游离半腱肌行静力重建,游离缝匠肌远端行动力重建。结果 20例手术切口Ⅰ期愈合,平均随访6个月,根据Lysholm膝关节量表计分方法评定治疗效果,优12例,良6例,可2例,优良率90%,应力位拍片内侧比健侧张开均小于5 mm,带线锚钉位置良好。结论自体半腱肌、缝匠肌移植重建内侧副韧带断裂能提供足够的张力,采用动静力结合法重建内侧副韧带,克服了韧带松弛的缺点,是一种理想的修复内侧副韧带断裂的方法。

Objective To investigate the effect of old medial collateral ligament injury reconstruction by motive and statics method using semitendinosus and seininmmbranosus tendon.Methods A total of 20 patients with old medial collateral ligament injury received knee examination by arthroscopy.All of the patients,10 cases had lateralmeniscus injury,and they received partial resection of the lateral meniscus;6 cases had anterior cruciate ligament（ACL） injury,and underwent bone-ligament-bone reconstruction.Medial collateral ligament reconstruction was performed by statics method using the semitendinosus tendon autograft in growth in the tibial tunne1,and performed by motive method using the seininmmbranosus tendon autograft ingrowth.Results Primary healing was achieved in all the cases.The function of the knee was regained in 6-month follow-up;The treatment effect was evaluated by Lysholm scoring.The resutls were excellent in 12 cases,good in 6 cases,fair in 2 case,and the rate of good was 90%.Stress X-ray examination showed that the medial joint space was smaller than the contralateral one by less than 5 mm,and the position of the interference screw was optima1.Conclusion Semitendinosus and seininmmbranosus autograft provide suficient tension for medial collateral ligament reconstruction.The method of motive and statics reconstruction overcome the shortcoming of tendon looseness,which is an ideal therapy for old medial collateral ligament injury.