膝关节置换术中内侧副韧带断裂的治疗及随访研究

Treatment of Medial Collateral Ligament during Total Knee Arthroplasty:a Short Term Follow-up Study

目的比较膝关节置换术中内侧副韧带(MCL)损伤后采用限制性关节假体或非限制性关节假体患者的术后膝关节功能。方法回顾性研究2005年1月至2010年12月期间膝关节置换术中发生医源性MCL损伤病例19例。术中对MCL损伤均予以缝合修补。术中采用更换限制性膝关节假体者8例(LCCK组),采用术前计划的假体类型不变者11例(LPS组)。采用膝关节功能评分(KSS)评估术后膝关节功能,比较2组有无差异。全部患者均得到随访,术后随访时间5年。结果在末次随访中(60个月),LCCK组膝关节KSS评分为87.4分,而LPS组为93.3分。11例采用非限制性膝关节假体的患者没有因为膝关节不稳定而翻修;2例采用限制性假体的患者因为关节松动而进行了翻修手术。结论在膝关节置换术中发生MCL损伤往往需要修复MCL,膝关节假体类型可能不需要更换为限制性假体。

Objective To compare the knee function in patients with intraoperative medial collateral ligament（MCL）injury treated with or without increased prosthetic constraint. Methods The records of 19 cases who encountered with iatrogenic injury to the MCL during total knee arthroplasty（TKA）between January 2005 and December 2010 were retrospectively reviewed. Eight patients（LCCK group）were treated with increased prosthetic constraint;the remaining 11 patients（LPS group）received increased prosthetic constraint between January 2005 and December 2010 served as controls. The MCL was repaired after TKA. The complications were observed after operation. Knee society scores（KSS）subjective knee scores were used to assess the knee function. No patient was lost for follow-up. The mean follow-up was 5 years. Results Until last follow-up（60months）,The KSS subjective score was 87.4 for LCCK group compared with 93.3 for the LPS group. No revisions for knee instability were performed in the 11 patients treated with non-prosthetic constraint;however,2 patients treated with increased prosthetic constraint were revised due to joint loosening. Conclusion The MCL tear should be repaired during TKA;the type of the prosthesis should not be increased when MCL injury is recognized during TKA.