半腱肌腱和股薄肌腱转移修复人工全膝关节置换术中内侧副韧带损伤

SEMITENDINOUS AND GRACILIS TRANSFER FOR TREATMENT OF MEDIAL COLLATERAL LIGAMENT INJURY CAUSED BY TOTAL KNEE ARTHROPLASTY

目的探讨应用半腱肌腱和股薄肌腱转移修复人工全膝关节置换术（total knee arthroplasty,TKA）中内侧副韧带（medial collateral ligament,MCL）损伤的临床疗效。方法回顾分析2009年3月-2014年5月采用半腱肌腱和股薄肌腱转移治疗的11例（11膝）TKA术中MCL损伤患者临床资料（损伤组）,并与同期18例（21膝）TKA术中无MCL损伤患者（对照组）进行比较。两组患者性别、年龄、侧别、病程、体质量指数、膝关节内翻畸形程度及术前膝关节学会评分系统（KSS）评分比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组术后临床疗效,以KSS评分评价关节功能。结果术后两组患者切口均Ⅰ期愈合,未出现关节不稳、疼痛等并发症。两组患者均获随访,损伤组随访时间6~29个月,对照组7~34个月。末次随访时,损伤组KSS临床评分及功能评分分别为（89.82±3.76）分和（89.54±3.50）分,对照组分别为（90.19±3.39）分和（90.00±3.53）分,均显著高于术前,差异有统计学意义（P〈0.05）;两组末次随访时KSS临床评分及功能评分比较,差异均无统计学意义（t=0.158,P=0.877;t=0.820,P=0.432）。X线片复查示,随访期间两组假体均无松动、下沉发生。结论对于TKA术中MCL损伤,可选择半腱肌腱和股薄肌腱转移修复,半腱肌腱和股薄肌腱止点接近MCL止点,移位后解剖重建MCL,膝关节功能恢复满意。

Objective To evaluate the effectiveness of semitendinous and gracilis transfer for the treatment of medial collateral ligament（MCL） injury caused by total knee arthroplasty（TKA）. Methods Between March 2009 and May 2014, 11 patients（11 knees） with MCL injuries caused by primary TKA were treated by semitendinous and gracilis transfer in primary TKA（injury group）. Another 18 patients（21 knees） without MCL injury were included as the control group. There was no significant difference in gender, age, injury sides, disease duration, body mass index, knee varus deformity, and preoperative Knee Society Score（KSS） between 2 groups（P〈0.05）, with comparability. KSS score was used to evaluate the function after operation. Results Primary healing of incision was obtained in all patients, and no complications of joint instability and pain occurred. The follow-up time was 6-29 months in injury group and was 7-34 months in control group. At last follow-up, the KSS clinical score and functional score were significantly increased to 89.82±3.76 and 89.54±3.50 in the injury group（P〈0.05） and were significantly increased to 90.19±3.39 and 90.00±3.53 in the control group（P〈0.05） respectively, but no significant difference was shown between 2 groups（t=0.158, P=0.877; t=0.820, P=0.432）. X-ray films showed no prosthetic loosening or subsidence during follow-up. Conclusion The semitendinous and gracilis transfer is reliable for the treatment of MCL injury caused by TKA. The insertions of semitendinous tendon and gracilis are close to that of the knee MCL, which can effectively improve knee function.