中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (8): 724-729.doi: 10.12007/j.issn.0258-4646.2018.08.013

• 论著 • 上一篇    下一篇

异体跟腱与自体半腱肌肌腱移植治疗内侧副韧带体部Ⅲ度损伤的疗效

杨岩1, 姚鲁田1, 王岩峰1, 王新贤2, 王汉宁1, 张杭州1, 周鑫1   

  1. 1. 中国医科大学附属第一医院运动医学科及关节外科病房骨科, 沈阳 110001;
    2. 辽宁省金秋医院超声科, 沈阳 110015
  • 收稿日期:2017-09-11 出版日期:2018-08-30 发布日期:2018-08-17
  • 通讯作者: 姚鲁田 E-mail:cmuyaolt@163.com
  • 作者简介:杨岩(1983-),男,讲师,博士研究生.

Curative Treatment of Grade Ⅲ Medial Collateral Ligament Injury Using Semitendinosus Tendon Autograft and Achilles Tendon Allograft

YANG Yan1, YAO Lutian1, WANG Yanfeng1, WANG Xinxian2, WANG Hanning1, ZHANG Hangzhou1, ZHOU Xin1   

  1. 1. Sports Medicine and Joint Surgery/Orthopaedics, The First Hospital, China Medical University, Shenyang 110001, China;
    2. Department of Ultrasound, Jinqiu Hospital of Liaoning Province, Shenyang 110015, China
  • Received:2017-09-11 Online:2018-08-30 Published:2018-08-17

摘要: 目的 回顾性分析内侧副韧带(MCL)体部Ⅲ度损伤后采用同种异体跟腱与取健侧半腱肌肌腱移植2种方法重建MCL的疗效,探讨MCL体部Ⅲ度损伤的治疗方法。方法 2009年7月至2016年1月我院共收治Ⅲ度MCL损伤患者79例,根据MCL损伤部位以及是否伴发其他类型损伤从中选取40例患者,其中同种异体跟腱移植重建21例(异体跟腱组),取健侧半腱肌肌腱重建19例(自体半腱肌组)。记录手术前后膝关节活动度、膝关节内侧开口间隙差值(外翻应力试验下摄像,双侧)、国际膝关节文献委员会(IKDC)评分及Lysholm评分,记录术后并发症发生情况及不同时期各项指标数值。结果 患者术后平均随访21.3(12~30)个月;2组术后各项指标均较术前明显改善(P<0.05)。术后自体半腱肌组出现1例取腱切口延迟愈合;异体跟腱组出现1例切口区脂肪液化,对出现并发症的切口进行清创、负压吸引装置处理创面后Ⅱ期愈合,1例异体跟腱组多发韧带损伤患者术后1年出现外翻Ⅰ度阳性。术后1周疼痛视觉模拟评分异体跟腱组明显优于自体半腱肌组(P<0.01);术后6个月复查膝关节MRI显示2组患者重建的MCL连续性良好。末次随访所有患者均未出现膝关节屈伸功能受限,2组间患者膝关节活动度、关节内侧开口间隙差值、Lysholm评分、IKDC评分及疼痛视觉模拟评分的差异均无统计学意义(P > 0.05)。结论 中期随访结果显示,取健侧半腱肌肌腱与同种异体跟腱移植重建MCL具有相同的手术效果。

关键词: 内侧副韧带, 体部Ⅲ度损伤, 外翻应力试验, 自体半腱肌, 同种异体跟腱, 重建

Abstract: Objective To retrospectively analyze the clinical efficacy of treating gradeⅢ medial collateral ligament(MCL) injury using a semitendinosus tendon autograft and Achilles tendon allograft. Methods We treated 79 patients with grade Ⅲ MCL injury between July 2009 and January 2016. Of 40 patients included in this study,21 received an Achilles tendon allograft (allogeneic Achilles tendon group) and 19 received a semitendinosus autograft taken from the healthy side(autogenous semitendinosus group). The range of motion (ROM),medial joint gap opening difference(radiographs during valgus stress test,side to side),International Knee Documentation Committee(IKDC) score,Lysholm score,preoperative findings in injured knees and postoperative complications were recorded and compared. Results All patients were followed up for an average of 21.3 (12-30) months postoperatively. The outcomes were significantly improved after surgery(P<0.05). Complications,such as liquefaction seepage,were successfully treated. The visual analog scale(VAS) scores in the allogeneic Achilles tendon group were significantly better than in the autogenous semitendinosus group at 1 week postoperatively(P<0.01). There was good continuity in the MCL on magnetic resonance imaging at 6 months postoperatively in both groups. The ROM,valgus medial opening difference,and Lysholm,IKDC,and VAS scores were also improved,but the differences between the two groups was not statistically significant (P > 0.05). Conclusion The curative effect of MCL reconstruction using allogeneic Achilles tendon and autogenous semitendinosus tendon was the same at midterm follow-up.

Key words: medial collateral ligament, grade Ⅲ body injury, valgus stress test, autogeneic semitendinosus, allogenic achilles tendon, reconstruction

中图分类号: 

  • R684.7
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