自体肌腱动静力结合重建陈旧性膝关节内侧副韧带断裂20例分析

Old Disruption of Medial Collateral Ligament Reconstruction By Motive and Statics Method with Autograft tendons:Report of 20 Cases

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，合并膝外侧半月板损伤9例，行半月板成形术，合并前交叉韧带损伤7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进行静力重建，游离缝匠肌远端行动力重建。结果：20例手术切口均I期愈合，平均随访7个月，依据Lysholm膝关节量表评定术后效果，优11例，良7例，可2例，优良率90．0％，应力位拍片内侧比健侧张开均小于5mm，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 observe the effect of old disruption of medial collateral ligament reconstruction by motive and statics method using semitendinosus and seininmmbranosus tendon. Methods： A total of 20 patients with old disruption of medial collateral ligament received knee examination by arthroscopy. All of the patients, 9 cases had lateralmeniscus injury and received partial resection of the lateral meniscus; 7 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 ingrowth in the tibial ttmnel, and performed by motive method using the seininmmbranosus tendon autograft ingrowth. Results： Primary healing was achieved in all the cases. The function of knee was regained in 6-month followed-up; The treatment effect was evaluated by Lysholm scoring. The results were excellent in 11 cases, good in 7 cases, fair in 2 case, and the excellent and good rate was 90.0%. Stress X-ray examination showed that the medial joint space was smaller than the contralateral one by less than 5mm, and the position of interference screw was optimal. Conclusions： Semitendinosus and seininmmbranosus autografl provide sufficient tension for medial collateral liga- ment reconstruction. The method of motive and statics reconstruction overcame the shortcoming of tendon looseness, which was an ideal therapy for old disruption of medial collateral ligament.