全膝关节置换术中医源性内侧副韧带损伤的处理方法及疗效分析

Treatment of iatrogenic injury to medial collateral ligament in total knee arthroplasty

目的探讨全膝关节置换术(TKA)中医源性内侧副韧带(MCL)损伤的处理方法及疗效。方法回顾性分析2009年1月至2016年12月期间郑州市骨科医院关节病科收治的14例初次TKA中医源性MCL损伤患者资料(损伤组)。男3例,女11例;年龄为(72.6±3.9)岁。MCL损伤类型:体部断裂9例,股骨止点撕脱5例。术中对体部断裂予以编织缝合,股骨止点撕脱采用带线锚钉或螺钉进行修复重建。4例患者修复后仍无法恢复内侧稳定,改用髁限制性假体。并以同期收治的21例初次TKA中MCL未损伤患者作为对照组,男5例,女16例;年龄为(73.2±3.9)岁。比较两组患者的美国膝关节协会评分(KSS)、膝关节屈曲活动度等。结果两组术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。损伤组14例患者术后获18~36个月(平均33个月)随访。损伤组3例应用非限制性假体患者术后18个月出现关节松动,行二次翻修术;其余11例患者术后36个月随访膝关节伸直和屈曲均正常,外翻应力试验无内侧松弛,KSS评分由术前(50.0±22.7)分提高至(93.3±4.7)分,膝关节屈曲活动度由术前90.4°±10.3°改善至110.7°±8.8°,差异均有统计学意义(P<0.05)。两组患者术后3、6、12、36个月KSS评分和膝关节屈曲活动度比较差异均无统计学意义(P>0.05)。结论对于初次TKA中的MCL损伤,应采用一期手术修复重建,且患者术后可获得与TKA中MCL未损伤患者相似的良好疗效。

Objective To explore the treatment of iatrogenic injury to the medial collateral ligament(MCL)in total knee arthroplasty(TKA).Methods From January 2009 to December 2016,14 patients were treated at Department of Arthropathy,Zhengzhou Orthopedics Hospital for iatrogenic MCL injury in primary TKA(injury group).They were 3 males and 11 females with an age of(72.6±3.9)years.The MCL injury was body rapture in 9 cases and avulsion of femoral insertion in 5 ones.Interlacing suture was used for body rapture and reparative reconstruction with wire anchors or nails was performed for avulsion of femoral insertion.A restrictive condylar prosthesis was used instead in the 4 patients whose medial stability failed to be restored after repair of body rapture.A control group of 21 cases was enrolled who had suffered from no iatrogenic MCL injury in primary TKA at the corresponding period.There were 5 males and 16 females with an age of(73.2±3.9)years.The 2 groups were compared in terms of American Knee Society Score(KSS)and knee flexion.Results There was no significant difference between the 2 groups in preoperative general data,showing comparability between groups(P>0.05).The injury group was followed up for 18 to 36 months(mean,33 months).Joint loosening was observed at 18 months after operation in 3 patients with nonrestrictive prosthesis who had to receive secondary revision.At the 36-month follow-up of the remaining 11 patients,normal knee extension and flexion was observed,the stress test of valgus showed no inner relaxation,their KSS increased significantly from preoperative 50.0±22.7 to 93.3±4.7,and their knee flexion was improved significantly from 90.4°±10.3°to 110.7°±8.8°(P<0.05).There were no significant differences in KSS score or knee flexion between the 2 groups at 3,6,12 or 36 months after operation(P>0.05).Conclusion Iatrogenic MCL injury in primary TKA should be repaired and reconstructed by one-stage surgery because the patients can achieve curative results similar to those for the patients free from iatrogenic MCL injury in primary TKA.