中国修复重建外科杂志

中国修复重建外科杂志

非止血带下改良髌骨穿孔结合锚钉修复急性股四头肌腱骨腱结合部断裂

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目的 探讨采用非止血带下改良髌骨穿孔结合锚钉修复急性股四头肌腱骨腱结合部断裂的疗效。 方法 2010 年 6 月—2016 年 6 月,采用非止血带下改良髌骨穿孔结合锚钉技术修复 15 例急性股四头肌腱骨腱结合部断裂。男 14 例,女 1 例;年龄 19~74 岁,平均 44 岁。致伤原因:运动伤 7 例,扭伤 5 例,暴力伤 3 例。病程 3 h~3 d,中位病程 2 d。左侧 6 例,右侧 9 例。均为闭合性损伤。患者既往无肢体功能障碍后遗症、无肢体关节手术史。术后随访复查膝关节正侧位及髌骨轴位 X 线片;采用 Lysholm 评分和 Kujala 评分系统评价膝关节功能。 结果 手术时间 50~60 min,平均 55 min。术中出血量 50~150 mL,平均 87 mL。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间 12~24 个月,平均 18 个月。术后膝关节功能恢复良好,术后 1 年膝关节 Lysholm 评分为 92~96 分,平均 94 分;髌股关节 Kujala 评分为 90~95 分,平均 93 分。随访期间无股四头肌腱再断裂及锚钉松动发生。术后 1 年膝关节侧位及髌骨轴位片测量,髌骨深度指数 3.62~4.09,平均 3.84;滑车深度指数 4.45~6.50,平均 5.56;滑车面角 137~145°,平均 142°;Insall-Salvati 指数 0.90~1.18,平均 1.06。术后 1 年外侧髌股角较术前增大,髌骨倾斜角及髌骨外移度均较术前减小,比较差异均有统计学意义(P<0.05)。 结论 非止血带下改良髌骨穿孔结合锚钉技术修复急性股四头肌腱骨腱结合部断裂,能更好地重建稳定髌股关节,增加肌腱固定强度,有效均匀地分散应力,增加腱骨愈合面积。

Objective To investigate effectiveness of a improved technique for perforation of patella combined with suture anchor and non-tourniquet for repairing acute rupture of the bone tendon junction of quadriceps tendon. Methods Between June 2010 and June 2016, 15 patients with acute rupture of the bone tendon junction of quadriceps tendon were treated with the improved technique for perforation of patella combined with suture anchor and non-tourniquet. Of them, 14 were male and 1 was female, aged from 19 to 74 years (mean, 44 years). Seven cases were sports injuries, 5 cases were caused by slipping, and 3 cases were caused by violent trauma. The duration of quadriceps tendon rupture ranged from 3 hours to 3 days (median, 2 days). The right side was involved in 9 cases, and the left side in 6 cases. All of the cases were closed injuries. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films of the knee joint and patella axial films during follow-up. Knee function of the patients after operation was evaluated by Lysholm scoring system and Kujala scoring system. Results The operation time was 50-60 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL, with an average of 87 mL. Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, the knee joint function of all patients recovered well; the knee Lysholm score was 92-96, with an average of 94 and the patellofemoral joint Kujala score was 90-95, with an average of 93. There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. According to the lateral and axial X-ray films at 1 year after operation, the patella depth index, femur trochlea depth, sulcus angle, and Insall-Salvati index were 3.62-4.09 (mean, 3.84), 4.45-6.50 (mean, 5.56), 137-145° (mean, 142°), and 0.90-1.18 (mean, 1.06). The lateral patellofemoral angle increased, and the patellar tilt angle and the patella lateral shift distance reduced, all showing significant differences when compared with preoperative ones (P<0.05). Conclusion The improved technique for perforation of patella combined with suture anchor and non-tourniquet for repairing acute rupture of the bone tendon junction of quadriceps tendon can reconstruct a stable patellofemoral joint, increase the strength of fixing, disperse stress effectively and evenly, and increase the area for tendon-bone healing.

关键词: 股四头肌腱断裂; 内侧髌股韧带; 髌股关节; 缝线锚钉; 髌骨穿孔技术

Key words: Quadriceps tendon rupture; medial patellofemoral ligament; patellofemoral joint; suture anchor; patella drilling technique

引用本文: 吴国忠. 非止血带下改良髌骨穿孔结合锚钉修复急性股四头肌腱骨腱结合部断裂. 中国修复重建外科杂志, 2017, 31(12): 1428-1433. doi: 10.7507/1002-1892.201707044 复制

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