切开清创联合双排锚钉桥样缝合固定治疗重度髌腱末端病的临床效果

The treatment effect of opening,debridement and double-row fixation using suture anchor for severe patellar tendinopathy

目的探讨内外排锚钉桥样缝合技术治疗慢性、重度髌腱末端病的临床效果。方法回顾性分析2009年1月至2014年6月首都医科大学附属北京朝阳医院骨科收治的18例(24膝)行切开清创联合双排锚钉桥样缝合固定治疗的重度髌腱末端病患者的临床资料。其中男性10例(12膝),女性8例(12膝);左膝7例,右膝17例;年龄47.2岁(范围:32~63岁)。所有患者均经>6个月保守治疗(范围:6~30个月),效果不佳,后改行手术治疗。患者术中行髌腱正中切开、病灶彻底清创、内外排带线锚钉桥样缝合固定。收集患者手术前后视觉模拟评分(VAS)、Lysholm膝关节评分及手术并发症情况等。符合正态分布的计量资料以x±s表示,采用配对样本t检验进行统计学分析。结果所有患者均获得随访,随访时间35.7个月(范围:24~64个月)。患者的VAS评分由术前的(7.5±1.6)分降至末次随访时的(1.4±1.0)分(t=4.45,P=0.00),Lysholm评分由术前的(48.3±5.2)分升至(89.6±5.4)分(t=-4.88,P=0.00),差异均有统计学意义。术后Lysholm评分优秀3例,良好15例。术后随访未发现髌腱断裂等术后并发症或缝合固定失败等。结论双排锚钉桥样缝合技术治疗重度髌腱末端病的效果较好,可改善患者的临床症状,较快恢复膝关节功能。

Objective To evaluate clinical treatment efficacy of double-row fixation with bridging suture anchors for chronic,severe patellar tendinopathy.Methods A retrospective study of 18 patients suffered from severe patellar tendinopathy and underwent surgical treatment during January 2009 and June 2014 at Department of Orthopedic,Beijing Chao Yang Hospital,Capital Medical University was conducted.All patients had received conservative therapy for more than 6 months(range:6-30 months)but the effect was unsatisfactory.There were 10 males(12 knees)and 8 females(12 knees)with age of 47.2 years(range:32-63 years).Seven cases on the left and 17 cases on the right.The surgical treatment included a midline incision at patellar tendon,complete debridement,and double-row fixation with bridging suture anchors.Visual analogue scale(VAS),Lysholm score were collected preoperatively and postoperatively,and compared by paired-t test.The postoperative complications was recorded.Results All patients were followed up for 35.7 months(range:24-64 months)without any dropout.VAS decreased from 7.5±1.6 preoperative to 1.4±1.0(t=4.45,P=0.00)postoperative,Lysholm score increased from 48.3±5.2 to 89.6±5.4(t=-4.88,P=0.00).The Lysholm score was excellent in 3 cases and good in 15 cases.No patellar tendon rupture or suture fixation failure was recorded during the follow-up period.Conclusions The effect of double-row fixation with bridging suture anchors is satisfactory with few postoperative complications.It can not only improve clinical symptoms of patients,but also restore knee joint function.