LARS韧带与自体腱重建髌韧带治疗急性髌韧带近止点断裂

LARS artificial ligament versus semitendinosus tendon autograft for acute patellar tendon rupture near insertion

[目的]比较LARS人工韧带与自体半腱肌移植重建髌韧带治疗急性髌韧带近止点断裂的疗效。[方法]2008年7月～2018年6月本院共收治髌韧带断裂患者41例,近止点部断裂21例纳入本研究,采用LARS人工韧带10例,自体半腱肌移植重建11例。记录围手术期资料,测量髌上10cm大腿周径、膝关节活动度,利用Lysholm及Kujala评分对膝关节进行功能评价,行影像检查,测量Caton指数。[结果]所有患者均顺利手术,无严重并发症。LARS韧带组手术时间、术中失血量、术后3d VAS评分显著优于自体肌腱组(P<0.05);但LARS韧带组手术费用显著高于自体韧带组(P<0.05)。两组患者随访7～36个月。末次随访两组术后各项指标均较术前明显改善(P<0.05),两组患者间末次随访时膝关节活动度、髌上10 cm大腿周径、Lysholm评分和Kujala评分的差异均无统计学意义(P>0.05)。所有患者均未出现膝关节功能受限,优良率100%。[结论]LARS人工韧带与自体半腱肌移植重建髌韧带治疗急性髌韧带近止点断裂均能够有效修复伸膝装置及恢复膝关节功能,具有相同的手术效果。

[Objective] To compare the clinical outcomes of LARS artificial ligament versus semitendinosus tendon autograft for repairing acute patellar tendon rupture near insertion. [Methods] From July 2008 to June 2018, 41 patients underwent surgical treatment in our department for patellar tendon rupture. Of them, 21 patients who suffered from patellar tendon rupture near to the insertion were enrolled into this study, including 10 patients who had torn tendon repaired by LARS artificial ligament, and 11 patients who underwent repairing with semitendinosus tendon autograft. The perioperative parameters were recorded, the thigh circumferential length 10 cm above the knee and knee range of motion were measured, the Lysholm score and Kujala score were used and the Caton index was determined on radiographs for comparison between the two group. [Results] All the patients had operation performed smoothly without serious complications. The LARS group proved significantly superior to the autograft group regarding to operation time, intraoperative blood loss and VAS score at 3 days postoperatively(P<0.05), although the LARS group consumed significantly higher fee than the autograft group(P<0.05). The patients were followed up for7~36 months. At the latest follow up all the clinical parameters significantly improved compared with those before operation(P<0.05). There were no statistically significant differences in ROM, thigh circumferential length 10 cm above knee, Lysholm and Kujala scores between the two groups(P>0.05). All the patients had the patella returned to the normal position without significant limitation of knee function, with excellent and good rate of 100%. [Conclusion] Both the LARS artificial ligament and semitendinosus tendon autograft are sound choices for repairing patellar tendon rupture near to the insertion to restore function of knee extension mechanism with similar clinical outcomes.