保留止点自体肌腱移植治疗陈旧性髌韧带断裂

Autologous tendon graft with preserved distal insertions for the treatment of old patellar tendon rupture

背景:髌韧带在膝关节的运动中起着非常重要的的作用,因其断裂比较少见,临床上误诊率较高。目前重建髌韧带的方法较多,疗效报道不一,治疗不当容易出现髌骨位置不良,会严重影响膝关节的功能。目的:探讨保留止点自体肌腱移植治疗陈旧性髌韧带断裂的临床疗效。方法:对8例单侧陈旧性髌韧带断裂的患者行保留止点的半肌腱、股薄肌重建髌韧带,髌韧带重建后行半环形石膏后托固定屈膝15°1周,髌韧带重建后2周拆除切口缝线,3周去除石膏行股四头肌等长等张练习,6周时佩戴可调节膝关节护具进行膝关节活动度锻炼,3次/d,每周增加10°。髌韧带重建3个月后允许完全负重行走。结果与结论:所有患者髌韧带重建后无并发症,X射线示髌骨恢复正常高度。膝关节功能恢复良好。所有患者髌韧带重建后24个月行走2km以上膝关节无不适。与髌韧带重建前相比,髌韧带重建后24个月患者的Lysholm评分明显增加(P<0.05),说明保留止点的半腱肌、股薄肌重建髌韧带可重建治疗陈旧性髌韧带断裂。

BACKGROUND： Patellar tendon plays a very important role in the movement of knee joint. Patellar tendon rupture is relatively rare in clinic, so the misdiagnosis rate is high. There are many ways for patellar ligament reconstruction and the therapeutic effect is very different. Improper treatment can lead to patella malpositionthat would seriously affect the function of the knee joint. OBJECCTIME： To explore the clinical efficacy of autologous tendon graft with preserved distal insertions on the treatment of old patellar tendon rupture. METHODS： Eight patients with unilateral old patellar tendon rupture underwent reconstruction using semitendinosus-gracilis tendons with preserved distal insertions. After patellar ligament reconstruction, semi-circular gypsum was used for fixation and the knee joint was kept in flexion of 15° for 1 week. At 2 weeks after patellar ligament reconstruction, surgical incision suture was removed, and 2 weeks later, gypsum was removed for quadriceps isometric and isotonic exercises. At 6 weeks after reconstruction, adjustable knee brace was used for the range of motion exercise, three times per day, and the flexion angle was increased for 10° every week. The patients had fully weight-bearing walking at 3 months after patellar ligament reconstruction. RESULTS AND CONCLUSION： All patients had no complications after patellar ligament reconstruction, and X-ray film showed that the patella returned to normal height. Function of knee joint had generally returned to normal. No patient had knee discomfort after walking for two kilometers in 24 months. Compared with that before patellar ligament reconstruction, Lysholm score of the patients at 24 months after reconstruction was increased significantly （P 〈 0.05）. The results indicate that semitendinosus-gracUis tendons with preserved distal insertions used for patellar ligament reconstruction can reconstruct and treat old patellar tendon rupture.