Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion:A case report and review of literature

BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Presentation and management outcome of foot drop with tibialis posterior tendon transfer

BACKGROUND Foot drop causes considerable disability.The ankle-dorsiflexion is either weak or lost completely.Additionally,the ankle eversion and toe extensions are also impaired.This results in a high steppage gait while walking.Overall,the gait is awkward;there is greater energy consumption;increased proneness to sustain injury of the forefoot;and more frequent falling during walking.AIM To document the clinical and epidemiological profile of foot drop patients in our population and evaluate the outcome of tibialis posterior(TP)tendon transfer for restoring the lost dorsiflexion in foot drop.METHODS The study was carried out at the National Institute of Rehabilitation Medicine in Islamabad over a period of 7 years.It included patients of all sexes and ages who presented with foot drop and had no contraindications for the procedure of TP tendon transfer.Exclusion criteria were patients who had contraindications for the operation.For instance,paralyzed posterior leg compartment muscles,Achilles tendon contracture,stiff ankle or toes,unstable ankle joint,weak gastrocnemius and scarred skin spanning over the route of planned tendon transfer.Also,patients who had the foot drop as a result of disc prolapses or brain diseases were excluded.Convenience sampling technique was used.The circum-tibial route of TP tendon transfer was employed.RESULTS Out of 37 patients,26(70.27%)were males whereas 11(29.72%)were females.The mean age was 22.59±8.19 years.Among the underlying causes of foot drop,road traffic accidents constituted the most common cause,found among 20(54.05%)patients.The share of complications included wound infections in 3(8.10%)patients and hypertrophic scars in 2(5.40%)patients.At 1-year postoperative follow-up visits,the outcome was excellent in 8(21.62%),good in 20(54.05%)and moderate in 9(24.31%).CONCLUSION The majority of cases of foot drop resulted from road traffic accidents that directly involved the common peroneal nerve.TP tendon transfer through the circumtibial route was found to be an easily executed effective operation which restored good dorsiflexion of the ankle among the majority of patients.

Introducing the Principles of Tendon Transfer for Surgical Trainees to Improve Anatomical Knowledge

This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatomical knowledge in surgical trainees preparing for surgical examinations. Post intervention surveys showed an improvement in trainees’ familiarity with musculoskeletal anatomy and engagement in learning with improved readiness for surgical examinations.

Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

Background:The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds,resulting in drop-hand syndrome.The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.Methods:This level-II,prospective,comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017.The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension.The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension.The flexor carpi radialis was transferred to the extensor digiti communis for 2 nd,3 rd,4 th,and 5 th finger extension.All outcomes of thumb abduction and extension,wrist extension,wrist flexion,and finger extension were assessed.Results:There was a high level of radial nerve injury in all patients included in the study.The time from injury to treatment ranged from 1.5 months to 9 months.The mechanism of injury most commonly observed was a gunshot wound,which was observed in 8 patients(61.5%),followed by a penetrating cutting tool injury(n=3;23.1%)and humerus fracture(n=2;15.4%).Conclusions:In radial nerve injuries,successful results can be achieved with tendon transfer.All patients regained thumb abduction of up to approximately 60°.All the patients were able to bend the wrist,grip,and extend the fingers while in wrist flexion,neutral wrist and wrist extension positions.Although the reason for the radial injury varied,the postoperative outcomes were good for all patients,and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

Anatomic relationship of extensor indicis propius and extensor digitorum communis: Implications for tendon transfer

BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.

Hallux valgus deformity treated with the extensor hallucis longus tendon transfer by dynamic correction

Background Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively.We designed and caried out operations to correct hallux valgus by transferring the extensor hallucis longus （EHL） tendon to reduce the likelihood of recurrence.Methods Twenty-five patients （38 feet） with the average age of （46.3±12.3） （range, 22 to 60） years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of （38.2±3.2） months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.Results At follow-up, 35 feet （23 patients, 85%） were free from pain at the first metatarsophalangeal （MTP） joint. In three feet （two patients）, the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3°±8.0° to 7.3°±2.0° at the time of the most recent follow-up （P 〈0.0001）, and the mean intermetatarsal （IM） angle decreased significantly from preoperative 12.5°±3.4° to postoperative 6.5°±2.4° （P 〈0.0001）. The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points （P 〈0.0001）.Conclusions Hallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion.The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.

单套索人工肌肉的力学特性建模及试验分析

套索传动机构因具有传动路径灵活、柔顺性强等特点而被广泛应用于机器人传动系统,尤其是在机器人的仿生设计中经常将套索传动与人工肌肉相结合实现远距离柔顺驱动。然而套索传动系统中存在明显的非线性因素,这对套索人工肌肉整体传递特性有较大影响。为探究套索人工肌肉传递特性的影响因素,基于Cloulomb摩擦模型及Lugre摩擦模型理论分别建立了传动系统的静态模型和动态模型,并搭建了试验台探究与验证其力/位移的传递特性,试验结果与仿真结果基本一致。试验结果表明,全曲率和摩擦力是影响套索传动效率的主要因素,并联弹性元刚度过大和串联弹性元刚度过小均会降低套索人工肌肉的效率。本文的研究为基于Hill模型的套索人工肌肉的应用提供了理论指导。

巨大肩袖损伤的临床治疗新进展

肩袖损伤是肩部常见疾病,尤其在运动员和中老年人中更为普遍。随着人口老龄化趋势加快,肩袖损伤患者数量呈增长态势。对于巨大肩袖损伤,其手术后再次撕裂的风险较高,预后较差,这对临床而言是一项重要挑战。近年来,针对巨大肩袖损伤的手术技术不断创新,包括上关节囊重建术、肩峰下球囊技术、肌腱转位术和反向肩关节置换术等。本文总结了巨大肩袖损伤对肩关节生物力学的影响,并关注了最新的治疗进展,以期为临床治疗提供新的参考依据。

Fracture of ossified Achilles tendons:A review of cases

Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.

单切口踇长屈肌腱转位治疗Haglund综合征并发急性跟腱断裂

目的探讨单切口跟骨后上结节及变性跟腱切除,踇长屈肌腱转位术治疗Haglund综合征并发急性跟腱断裂的临床疗效。方法回顾性分析武汉市第四医院足踝外科2018年1月至2020年1月收治的40例Haglund综合征并发急性跟腱断裂患者的临床资料,均行跟骨后上结节切除,踇长屈肌腱转位术。记录患者术前、术后3个月、术后6个月及末次随访的美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝与后足功能评分、维多利亚运动评估学院-跟腱问卷(Victorian Institute of Sports Assessment-Achilles questionnaire, VISA-A)、跟腱完全断裂评分(Achilles tendon total rupture score, ATRS)及Leppilahti评分评价临床结果。末次随访时采用Arner-Lindholm评分标准评估疗效。记录测量患者术前、术后3个月、术后6个月及末次随访的跟骨后角(Fowler-Philipp angle, FPA)、X/Y比值和平行间距线(parallel pitch lines, PPL)评价影像学结果。结果40例患者均获得随访,随访时间为(16.87±2.78)个月(12~24个月)。患者均顺利完成手术,无神经、血管损伤等并发症。与术前相比,术后3个月、术后6个月及末次随访时AOFAS评分、ATRS评分、Leppilahti评分及VISA-A评分显著增加,差异有统计学意义(P<0.05)。采用Arner-Lindholm评分标准,临床结果评定为优36足,良4足,优良率为100%。所有患者切口一期愈合,踝关节背伸跖屈功能正常。影像学方面,与术前相比,术后3个月,术后6个月及末次随访时,FPA显著减小,X/Y比值显著增大,差异有统计学意义(P<0.05),PPL阳性率由术前的100%减少为7.5%,影像学表现显著改善。结论对于Haglund综合征并发急性跟腱断裂的患者,应用单切口跟骨结节及变性跟腱切除,踇长屈肌腱转位的手术可获得满意的临床疗效,该术式具有操作简单、肌腱固定坚强可靠,术后并发症少等优点,术后可以有效解除患者痛苦,恢复跟腱功能,值得临床推广应用。

Lateral Intra-Articular Transposition of the Anterior Tibialis Tendon for the Treatment of Relapsed Clubfoot in Toddlers: A Previously Unreported Surgical Technique

Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.

Extensor Pollicis Longus Tendon Rupture after Non-Displaced Extra-Articular Distal Radius Fracture: A Case Report

Background: Spontaneous tendon rupture of hand is not frequent. These ruptures can occur after a fracture. Aim: We report a case of spontaneous rupture of extensor pollicis longus tendon, and describe the treatment. Case presentation: We report the case of a 63-year-old woman who had extensor pollicis longus tendon rupture after non-displaced extra-articular distal radius fracture, treated by wrist circular cast immobilization. Extensor indicis proprius tendon transfer was performed, with an excellent functional result. Conclusion: Extensor pollicis longus tendon rupture can occur after non-displaced extra-articular distal radius fracture. Its treatment by tendon transfer helps to restore function of hand.

Muscles Transfer around the Shoulder in Cases of Brachial Plexus Birth Palsy

Background:?Disabling internal rotation contractures are frequently experienced in children with unresolved birth brachial plexus palsies. Multiple surgical options like muscle release, tendon transfer, or humeral osteotomy are available to treat such cases. Purpose:?Evaluation of the outcome of subscapularis release and latissimus dorsi and teres major tendon transfer in the management of obstetric brachial palsies in Mansoura University neurosurgical department. Study type: Retrospective observational study. Patients and Methods: Twenty-five cases who underwent subscapularis release and latissimus dorsi and teres major transfer were included in the study. All patients were subjected to complete history taking, through clinical examination. The degree of shoulder movement and disability was assessed via Modified Gilbert shoulder evaluation scale. Results: The least follow up period for our patients was 9 months. There was a clear improvement of shoulder function evaluated using Modified Gilbert shoulder evaluation scale as there were 73% of postoperative group between GIV and GV while about 84% of preoperative group were between GII and GIII. Conclusion: Tendon transfer is a valid easy procedure for correction of shoulder deformities in patients with obstetrical brachial plexus palsy. It is considered a very good option for patients who missed the chance of microsurgical repair or patients with poor shoulder recovery after surgery. Although some authors reported deterioration of shoulder function with log time follow up after tendon transfer, it is still better than those who were not operated.

Late Secondary Rupture of Flexor Tendons in the Palm of the Hand

Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.

胫骨后肌腱转移术研究进展

胫骨后肌腱转移术是平衡足踝部肌肉力量的重要的手术方式。胫骨后肌腱转移术手术时机依据原发疾病而定,转移的路径有经骨间膜和经胫骨前内侧两种方式。经骨间膜转移有更好的生物力学、更好的踝关节范围和较少的足内翻发生率,而经胫骨前内侧转移主要适用于骨间膜存在硬化的情况。转移后的胫骨后肌腱固定至骨性结构愈合好,但不适合足部骨质差的病人。胫骨后肌腱由于长度较短,有时可能达不到预定的固定位置,此时可以通过扩大骨间膜窗口、缝合至踝关节近侧的肌腱来克服。该手术是否致平足的发生,取决于原发疾病和足踝部肌肉力量的分布。胫骨后肌腱转移至足背为不同时相的肌腱转移,同时,由于胫骨后肌腱的滑动距离较短,需要结合系统科学的康复训练,方能取得好的治疗效果。本文对近年来胫骨后肌腱转移术研究进展进行综述。

腓骨骨膜移位法治疗踝关节骨折并下胫腓联合分离的临床疗效

目的观察腓骨骨膜移位法治疗踝关节骨折并下胫腓联合分离的临床疗效。方法回顾性选取2020年2月至2022年2月北京市丰台中西医结合医院收治的踝关节骨折并下胫腓联合分离患者97例,依据手术方法不同分为腓骨骨膜移位法组(n=51)和短肌腱移位法组(n=46)。对比分析两组患者的围手术期指标[术中出血量、术中C型臂X线机透视次数、操作角度、手术时间、固定时间、完全负重时间、骨折愈合时间、术后1个月视觉模拟评分法(VAS)评分]、关节形态[内侧关节间隙(MW)、下胫腓间隙(TBCS)、下胫腓重叠距离(TBOL)]、骨代谢指标[β-I型胶原羧基端交联肽(β-CTX)、骨碱性磷酸酶(BALP)、骨钙素、踝关节活动度[外翻、内翻、跖屈、背伸]、踝关节功能[Baird评分、Maryland评分、美国足与踝关节协会(AOFAS)踝-后足评分、足踝功能障碍指数(FADI)]、临床疗效及并发症发生情况。结果腓骨骨膜移位法组患者的术中出血量、术中C型臂X线机透视次数均少于短肌腱移位法组,操作角度大于短肌腱移位法组,手术时间长于短肌腱移位法组,固定时间、完全负重时间均短于短肌腱移位法组,术后1个月VAS评分低于短肌腱移位法组,差异均有统计学意义(P<0.05),但两组患者的骨折愈合时间比较,差异无统计学意义(P>0.05)。腓骨骨膜移位法组患者的MW、TBOL、BALP、骨钙素水平均明显高于短肌腱移位法组,TBCS、β-CTX水平均明显低于短肌腱移位法组,差异均有统计学意义(P<0.05)。腓骨骨膜移位法组患者的外翻、内翻、跖屈、背伸、Baird评分、Maryland评分、AOFAS评分、FADI评分均明显高于短肌腱移位法组,差异均有统计学意义(P<0.05)。腓骨骨膜移位法组患者的优良率明显高于短肌腱移位法组,差异有统计学意义(P<0.05)。腓骨骨膜移位法组患者的并发症发生率明显低于短肌腱移位法组,差异有统计学意义(P<0.05)。结论腓骨骨膜移位法手术治疗踝关节骨折并下胫腓联合分离的临床效果明显优于短肌腱移位法,更能减少患者的术中出血量、术中C型臂X线机透视次数,增大操作角度,缩短固定时间,缓解患者疼痛,提早患者完全负重时间,改善患者骨代谢,增大患者踝关节活动度,改善患者踝关节功能,提升临床疗效,并减少患者术后并发症的发生。

食指固有伸肌腱移位重建拇长伸肌功能及评价

目的 评价采用食指固有伸肌腱移位重建拇长伸肌功能的临床疗效。 方法 对 1978年 8月～ 2 0 0 3年 3月以食指固有伸肌移位重建拇长伸肌功能的 4 6例患者进行随访、评价。其中男 32例 ,女 14例。年龄 16～ 5 1岁 ,平均 36岁。外伤陈旧性断裂 2 4例 ,继发性断裂 2 2例。病程 2天～ 5个月 ,平均 74天。 结果 4 1例获 7个月～ 2 3年随访 ,平均 9年 3个月。术后拇指抬高丢失 0～ 2 .2 cm,平均 1.8cm;拇指屈曲丢失 0～ 3cm,平均 1.6 cm;食指均能单独背伸 ,背伸丢失 0～ 8度 ,平均 5度。按 SEEM评分标准 :优 2 9例 ,良 10例 ,可 2例 ,优良率达 95 %。 结论 食指固有伸肌腱移位重建拇长伸肌功能是一种简便、有效的方法 ,采用

趾长屈肌腱和长屈肌腱移位修复陈旧性跟腱断裂

目的:探讨趾长屈肌腱、长屈肌腱移位修复陈旧性跟腱断裂的手术方法和疗效。方法:13例陈旧性跟腱断裂患者,男9例,女4例;年龄32～69岁,平均41岁;左侧8例,右5例;受伤至手术时间3～8个月,平均4.5个月。13例患者均有明确外伤史,均为闭合性损伤跟腱断裂。采用趾长屈肌腱移位修复陈旧性跟腱断裂5例,行长屈肌腱移位修复陈旧性跟腱断裂8例。结果:13例随访时间11个月～4.5年,平均2年,伤口无感染,跟腱无再断裂,踝关节活动基本正常,足背屈跖屈功能良好,未发生锤状趾畸形。按ArnerLindholm疗效评定标准评定,优9例(长屈肌腱移位修复6例,趾长屈肌腱移位修复3例),良3例(长屈肌腱移位修复2例,趾长屈肌腱移位修复1例),差1例(趾长屈肌腱移位修复)。结论:采用趾长屈肌腱、长屈肌腱移位修复陈旧性跟腱断裂的手术方法,可获得良好的疗效,是较理想的治疗方法。而采用长屈肌腱移位修复陈旧性跟腱断裂更趋近于合理。

关节镜下先进人工韧带加强系统和四股自体半腱肌腱重建前交叉韧带的疗效比较

目的比较关节镜下应用先进人工韧带加强系统(ligament advanced reinforcement system,LARS)和4股自体半腱肌腱重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的疗效,探讨LARS重建ACL的临床效果。方法2002年7月-2005年4月,分别采用LARS和4股自体半腱肌腱于关节镜下重建42例ACL断裂患者。半腱肌腱组(27例):男22例,女5例;年龄20～52岁。运动伤12例,交通伤8例,其他损伤7例。左膝16例,右膝11例。Lysholm膝关节评分为(50.70±6.68)分。病程2～12个月。LARS组(15例):男12例,女3例;年龄17～40岁。运动伤8例,交通伤4例,其他损伤3例。左膝6例,右膝9例。Lysholm膝关节评分为(50.20±6.22)分。病程3～12个月。两组患者间各项指标差异均无统计学意义(P>0.05)。结果两组患者术后伤口均Ⅰ期愈合,无并发症发生。半腱肌腱组均获随访22～43个月,LARS组均获随访18～40个月。术后12个月,半腱肌腱组5例(19%)患者屈膝30°时双膝差距>3 mm;LARS组3例(20%)>3 mm。半腱肌腱组Lysholm评分(87.80±3.41)分;LARS组为(88.90±3.30)分,组间差异无统计学意义(P>0.05)。参考Cameron等改良Lysholm评分的分级标准,半腱肌腱组:优18例,良7例,可2例,优良率为92.6%;LARS组优11例,良3例,可1例,优良率为93.3%;组间差异无统计学意义(P>0.05)。Tegner运动评级标准:半腱肌腱组3～6级,平均4.93级;LARS组3～7级,平均5.03级;组间差异无统计学意义(P>0.05)。半腱肌腱组中2例伸膝角度较对侧差约5°,5例屈膝较对侧差5～10°;LARS组患者关节活动度均恢复正常;组间差异有统计学意义(P<0.05)。两组患者均未出现急慢性滑膜炎表现。结论LARS重建ACL可取得与4股自体半腱肌腱相同的近期疗效,且明显缩短康复时间,随访2年未发现移植术后有滑膜炎等不良反应发生。

关节镜下双股半腱及股薄肌腱经双胫骨隧道解剖重建膝前交叉韧带

目的:介绍在关节镜下应用自体双股半腱和股薄肌腱(DLSTG)经双胫骨隧道解剖重建膝前交叉韧带(ACL)的手术方法及术后随访结果。方法:在关节镜下对15例ACL断裂的患者行双胫骨隧道解剖重建。移植体股、胫骨端均采用近ACL解剖止点之Press fit技术固定。结果:全部患者于术后6～8周恢复了正常的关节活动和行走步态。手术12～16周后恢复了低风险体育运动。术后1年,2名患者的Lachman试验I度阳性;15名患者的IKDC评分为正常或接近正常;Tegner评分显示12名患者已恢复伤前运动水平;X线片示全部患者股骨、胫骨隧道无扩大。结论:关节镜下利用自体DLSTG及Press fit固定技术施行双胫骨隧道的ACL解剖重建在技术上可行,并有利于伤膝功能的快速恢复。