缝合桥技术修复尿毒症并发股四头肌腱断裂的疗效观察

EFFECTIVENESS OF A SUTURE BRIDGE TECHNIQUE FOR REPAIR OF QUADRICEPS TENDON RUPTURE IN URAEMIC PATIENTS

目的探讨采用缝合桥技术修复尿毒症并发股四头肌腱断裂的疗效。方法 2010年3月-2012年9月,采用缝合桥技术修复10例(14侧)尿毒症并发股四头肌腱断裂。男8例,女2例;年龄30~62岁,平均54.2岁。尿毒症病程3~11年,平均5.5年。股四头肌腱断裂5 d^2个月,中位病程12 d。其中6例有外伤史,1例合并糖尿病。左侧2例,右侧4例;双侧4例。术前膝关节主动活动度为屈膝(115.0±8.3)°,伸膝(72.5±21.2)°。Lysholm评分为(19.5±16.3)分。X线片检查示髌骨下移,MRI检查示股四头肌腱连续性中断。结果手术时间30~50 min,平均40.3 min。术后切口均Ⅰ期愈合,无并发症发生。患者均获随访,随访时间12~25个月,平均16.3个月。随访期间无股四头肌腱再断裂及内固定物松动发生。末次随访时,膝关节主动活动度为屈膝(121.0±7.9)°,与术前比较差异无统计学意义(t=—2.075,P=0.058);伸膝(8.2±6.1)°,与术前比较差异有统计学意义(t=11.702,P=0.000)。Lysholm评分为(84.6±12.4)分,与术前比较差异有统计学意义(t=—16.226,P=0.000)。按膝关节学会评分系统(KSS)评定疗效:优4侧,良9侧,可1侧,优良率92.9%。以45岁为界分为青年组和中老年组,以2周为界分为早期手术组和晚期手术组;末次随访时,青年组及早期手术组膝关节主动屈、伸活动度及Lysholm、KSS评分优于中老年组及晚期手术组(P<0.05)。结论采用缝合桥技术修复尿毒症并发股四头肌腱断裂创伤较小,允许术后早期功能锻炼,有利于膝关节功能康复。手术时机及年龄对预后有影响,肌腱断裂后宜尽早手术。

Objective To investigate the effectiveness of a suture bridge technique for quadriceps tendon rupture repair in uraemic patients. Methods Between March 2010 and September 2012, 10 uraemic patients （14 sides） with quadriceps tendon rupture were treated with the suture bridge technique. Of them, 8 were male and 2 were female, aged from 30 to 62 years （mean, 54.2 years）. The duration of uremia was 3-11 years （mean, 5.5 years）;the duration of quadriceps tendon rupture was 5 days to 2 months （median, 12 days）. Six cases had a trauma history, and one case had diabetes. The left side was involved in 2 cases, the right side in 4 cases, and both sides in 4 cases. The active range of motion （ROM） of the knees was （115.0 ± 8.3）° in flexion, and （72.5 ± 21.2）° in extension. Lysholm score was 19.5 ± 16.3. X-ray films showed downward shifting of patella. MRI revealed discontinuity between distal quadriceps tendon and upper pole of patella. Results The operation time was 30-50 minutes （mean, 40.3 minutes）. Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-25 months （mean, 16.3 months）. There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. At last follow-up, the active ROM of the knees was （121.0 ± 7.9）° in flexion, showing no significant difference when compared with preoperative one （t= — 2.075, P=0.058）; the active ROM was （8.2 ± 6.1）° in extension, showing significant difference when compared with preoperative one （t=11.702, P=0.000）. Lysholm score was 84.6 ± 12.4, showing significant difference when compared with preoperative score （t= — 16.226, P=0.000）. According to the American Knee Society score （KSS）, the results were excellent in 4 sides, good in 9 sides, and fair in 1 side, and the total excellent and good rate was 92.9%. At last follow-up, the active ROM of the knee, Lysholm score, and KSS score were significantly better in young patients （〈 45 years） than in elder patients （≥45 years）, and in patients receiving early operation （〈 2 weeks） than in patients receiving late operation （≥2 weeks） （P 〈 0.05）. Conclusion For fewer traumas and early functional exercise after operation, the suture bridge technique benefits functional restoration of knee joint in uraemic patients. Operation chance and age seem to be important factors to the results. Early operation should be considered when quadriceps tendon ruptured.