钢丝减张半腱肌移植修复重建陈旧性髌腱断裂

作者对 2例陈旧性髌腱断裂采用减张钢丝内固定加半腱肌联合修复重建断裂髌腱 ,获得满意效果 ,现报告如下。1　临床资料　 2例均为男性 ,年龄 2 6～ 30岁 ;左侧 1例 ,右侧 1例 ;均为陈旧性髌腱断裂 ;手术距伤后时间分别为 3个月 ,5个月 ;术前查体均不能主动伸膝 ,髌骨上移 ,并可上、下左右推动。膝前内侧“Ｓ”形切口显露髌骨、髌腱和胫骨粗隆 ,切除断面填充瘢痕。采用减张钢丝拉出法缝合从髌骨上缘缝合钢丝呈倒“ｎ”形 ,将髌骨向下推至正常位置 ,拉紧钢丝固定在胫骨粗隆下方内外侧定位螺帽上 ,然后取内侧半腱肌修复重建髌腱。术后长腿石膏…     

保留止点半腱肌、股薄肌肌腱重建修复陈旧性髌韧带断裂2例报告

目的探讨利用保留止点半腱肌、股薄肌肌腱重建修复陈旧性髌韧带断裂的的治疗方法和疗效。方法采用保留止点半腱肌、股薄肌腱横穿髌骨隧道后重叠缝合重建髌韧带并加用减张钢丝固定方法治疗2例陈旧性髌韧带断裂。结果2例患者均得到随访,分别随访18个月与24个月。术后2、3、6、12、18个月及2年分别对2例病人进行Lysholm评分,术后1年平均分达到80分以上,显示治疗结果为优。结论对于陈旧性髌韧带断裂患者,取半腱肌及股薄肌对其加强重建辅以钢丝内固定手术为临床操作方便、疗效较为可靠的方法。     

人工腱修复髌韧带效果观察

髌韧带断裂后膝关节的功能将受到很大影响 ,而对断裂的髌韧带尤其是陈旧性髌韧带断裂修复较困难 ,修复后拉力降低 ,对伸屈膝关节功能也有不同程度的限制。我们采用自己研制的新型人工腱—人发人工腱 (ＨｕｍａｎＨａｉｎＫｒａｔｉｎＡｒｔｉｆｉ ｃｉａｌ.Ｔｅｎｄｏｎ)ＨＨＫＡＴ修复断裂的髌韧带 ,取得满意效果。1　临床资料本组共 11例 ,男 9例 ,女 2例 ,工人 5例 ,农民 4例 ,战士 2例。年龄 18～ 2 5岁。新鲜断裂伤 3例 ,陈旧断裂伤 8例 ,其中二次断裂再次手术 6例。术后 10～ 12ｄ拆线 ,伤口不红肿 ,Ⅰ期愈合 ,不用石膏固定 ,3周开始…     

髌腱断裂修复与重建翻修临床体会

目的探讨并分析髌腱断裂重建及翻修的手术方式与临床疗效。方法我院2013年9月至2016年12月收治的髌腱断裂手术治疗患者8例,其中新鲜性髌腱断裂4例,男3例,女1例,年龄14～42岁;陈旧性髌腱断裂4例,男3例,女1例,年龄18～28岁。进行术后定期随访,并记录美国膝关节协会评分(knee society score,KSS)功能评分、KSS疼痛评分、股四头肌萎缩情况、髌骨高度。结果 8例患者均得随访,平均随访时间14个月,新鲜性髌腱断裂随访时间10～24个月,陈旧性髌腱断裂随访时间4～24个月。比较陈旧性髌腱断裂患者术后伤侧与健侧的KSS功能评分、KSS疼痛评分比较,差异有统计意义(P0.05),但无差异不具有显著性(P0.01),陈旧性髌腱断裂患者术后股四头肌萎缩有一定改善(P0.05),髌骨高度经适当的康复训练后,患者膝关节功能恢复均能取得良好的效果,本组髌腱断裂重建术后翻修患者术后随访膝关节功能评分较陈旧性髌腱断裂重建术患者稍低,差异无统计学意义(P0.05)。结论对于新鲜髌腱断裂患者,带线锚钉固定可提供足够的髌腱强度,陈旧性髌腱断裂利用半腱肌重建髌韧带配合钢丝带固定的临床疗效稳定,但需配合适当的术后功能锻炼。     

髌韧带断裂5例

髌韧带断裂文献报告较为少见 ,作者在 1982～ 1995年共收治 5例 ,现分析报告如下。1　临床资料本组均为男性 ,年龄 2 0～ 38岁 ;新鲜伤 2例 ,陈旧伤 3例 ;伤因 :开放性损伤 2例 ,余 3例均为间接暴力所致 ;5例髌腱损伤均位于髌骨下极 1～ 2ｃｍ处。2　治疗方法及结果所有患者均采用手术治疗。 2例新鲜伤采用丝线直接缝合。 3例陈旧性损伤 ,1例术前行髌骨牵引 ,另 2例做肌腱松解后行断端丝线缝合。 5例均采用了阔筋膜条加强 ,3例陈旧性损伤采用了减张钢丝固定 ,术后 8周去除减张钢丝。所有患者术后均伸膝位石膏固定 6周。本文 5例患者随访 6个…     

应用减张钢丝治疗陈旧性髌腱断裂

陈旧性髌腱断裂往往因漏诊而延误治疗。传统的治疗方法较多,但都存在术后膝关节固定时间长,关节功能受限及易复发等缺点。我们于１９９４年６月～１９９９年１２月对１８例陈旧性髌腱断裂者采用减张钢丝固定骸骨,同时以抽出钢丝修复断裂之髌腱,经过长期随访,效果良好。 临床资料 一、一般资料本组１８例,男１６例,女２例。年龄１７～５１岁。直接暴力１５例,间接暴力３例,髌腱断裂部位（将髌腱均分三等份）：上部１４例,中部２例,下部２例。其中左侧１１例,右侧７例,病程最短１个月,最长３个月。 二、临床表现及Ｘ线检查本组…     

动态髌骨牵引固定器治疗陈旧髌腱断裂

目的 探讨陈旧髌腱断裂的修复方法。方法 设计“井”形固定器，在动态条件下，将髌骨复位、股四头肌松懈、髌腱修补及术后带固定器活动。结果 治疗6例，随访时间8～56个月，平均2.6个月，膝关节伸屈活动取得了满意的治疗效果。结论 应用“井”形外固定器动态下，治疗陈旧性髌腱断裂，解决了髌腱、股四头肌挛缩，又有利于缝合修复后固定，还可早期练习膝关节功能。方法简单，是一种较为合理的新的治疗方法。     

钢丝空心钉治疗陈旧性髌韧带断裂4例

目的探讨钢丝空心钉治疗陈旧性髌韧带断裂手术治疗方法和疗效。方法 2005—2010年间利用钢丝加空心钉固定半腱肌移植修补术治疗陈旧性髌韧带断裂患者4例。均为男性;年龄30~45岁,平均36岁。结果 4例患者均得到12~24个月随访,平均18个月,1例膝关节伸直约缺失5°,1例8个月后钢丝断裂,进行Lysho lm评分,术后1年平均分达到80分以上,4例患者膝关节功能恢复良好,疗效均满意。结论钢丝空心钉治疗陈旧性髌韧带断裂手术效果肯定、简单易行,是一种治疗陈旧性髌韧带断裂的实用新方法。     

张力限制架治疗髌腱断裂

髌腱断裂的修补以往多采用抽出钢丝缝合法、髌韧带折叠的环形钢丝缝合法及其他改良缝合法 ,手术较复杂 ,且术后均需长腿石膏加以保护〔1〕,易引起膝关节僵直 ,拆除石膏后锻炼 ,因髌腱承受张力大 ,容易再断裂。我们采用自制的张力限制架治疗髌腱断裂 8例 ,获得满意疗效。1　材料与方法1.1　病例资料　本组 8例均为男性 ,年龄 17～ 5 4岁。左侧 3例 ,右侧 5例。新鲜断裂 6例 ,陈旧性断裂 2例。完全断裂 6例 ,不完全断裂 2例。撕裂伤 7例 ,切割伤 1例 ,其中带有髌骨下极小骨片 3例。1.2　手术器械　除常规手术器械外还包括电钻 1把 ,克氏针 2枚…     

锚钉结合Krackow和Bunnell缝合法治疗髌腱起点断裂

目的 应用锚钉结合Krackow和Bunnell缝合法治疗髌腱起点断裂,探讨此技术的临床应用效果.方法 3例髌腱起点断裂患者急诊手术,髌骨下极拧入3枚锚钉.髌腱两侧采用Krackow缝合和水平褥式缝合,中间采用Bunnell缝合.术后第1天开始功能锻炼,6个月后了解膝关节功能情况.结果 3例患者均获随访,术后6个月无锚钉松动或拔出,无屈伸膝关节受限.Lysholm膝关节评分在91～95分.结论应用锚钉结合Krackow和Bunnell缝合法治疗髌腱断裂,固定可靠,能够早期进行功能锻炼,缩短切口长度、减少手术时间,效果满意.     

Patellar tendon rupture repair using Dall-Miles cable

Ten patients underwent patellar tendon repair with end-to-end suture technique and medial and lateral retinacular repair, as well as reinforcement with a Dall-Miles cable through the patella and tibial tubercle. The cable was tensioned at 60 degrees of flexion to allow immediate range of motion to at least 100 degrees of flexion and to protect the repair from undue tension while healing. Accurate tendon length was obtained from a lateral radiograph of the noninvolved knee in 60 degrees of flexion. Patients were allowed to bear full weight as tolerated postoperatively. A knee immobilizer was worn for approximately 2 weeks when adequate muscular control of the leg was attained. The cable was removed 6-8 weeks postoperatively, at which time range of motion equal to the opposite extremity was sought. Full extension was obtained by 1 week postoperatively. Average postoperative knee flexion was 88 degrees at 2 weeks, 112 degrees at 1 month, 133 at 3 months, and 138 degrees at 6 months compared to flexion of 141 degrees in the noninvolved knee. Mean quadriceps muscle strength 1 year postoperatively was 72%+/-11% of the noninvolved leg. No patient had patella infera or rerupture after surgery. Repair of a patellar tendon rupture with end-to-end techniques reinforced with a Dall-Miles cable allows immediate rehabilitation without the need for prolonged immobilization. This technique allows restoration of full range of motion early postoperatively and enables patients to regain adequate quadriceps strength.     

Rupture of the quadriceps tendon: an association with a patellar spur

We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon. In the 88 available lateral radiographs, patellar spurs were present significantly more commonly (p < 0.0005) in patients operated on for rupture of the quadriceps tendon (79%) than in patients with rupture of the patellar tendon (27%) or fracture of the patella (15%). In patients presenting with failure of the extensor mechanism of the knee in the presence of a patellar spur, rupture of the quadriceps tendon should be considered as a possible diagnosis.     

Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation

The functional results of 28 cases of rupture of the quadriceps and patellar tendons are reported. Excellent or good results were noted in 15 of 18 quadriceps and 7 of 10 patellar tendons. Radiographic comparison with the opposite knee disclosed incongruences between the patella and the femoral groove in the tangential view and/or cranial-caudal position of the patella in the lateral view in 13 of the quadriceps tendon ruptures and seven of the patellar tendon ruptures. Patients with residual pain had patellofemoral incongruity but since two-thirds of the patients with incongruity were asymptomatic, incongruity alone may not be the cause of the symptoms. There was no positive correlation to muscular strength or range of movement. Nevertheless, exact adaptation of the patellar tendon and periarticular tissue seems necessary to obtain correct patello-femoral articulation. Reinforcement of the tendon with a wire cerclage is recommended to decrease the tension on the suture line and the consequent risk of a secondary rupture. In acute ruptures of the quadriceps tendon end-to-end sutures are sufficient.     

Quadriceps and patellar tendon ruptures

Ruptures of the quadriceps as well as the patellar tendon occur in low frequency, but cause major functional deficits of the leg. These injuries usually require operative treatment. Acute quadriceps tendon ruptures are treated by suture repair, using heavy sutures guided through bone tunnels in the patella. Chronic defects and neglected cases require a local tendon transfer, either by a quadriceps tendon turn-down or by a V-Y-plasty of the quadriceps tendon. Ruptures of the patellar tendon are treated by suture of the tendon stumps plus an reinforcement procedure protecting the tendon and avoiding secondary patella alta. Patello-tibial fixation may be achieved by a cerclage technique using wire or an autologous tendon strip, alternatively a patello-tibial external fixator can be applied. In chronic and neglected cases, patellar tendon reconstruction is performed with autologous tendon grafts or with soft tissue allografts. The graft must be protected by a patello-tibial fixation for the first weeks.     

Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure

Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.     

Quadriceps and patellar tendon rupture

Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.     

Patellar Tendon Ruptures

Rupture of the patellar tendon is a relatively infrequent, yet disabling, injury, which is most commonly seen in patients less than 40 years of age. It tends to occur during athletic activities when a violent contraction of the quadriceps muscle group is resisted by the flexed knee. Rupture usually represents the final stage of a degenerative tendinopathy resulting from repetitive microtrauma to the patellar tendon. This injury may also occur during less strenuous activity in patients whose tendons are weakened by systemic illness or the administration of local or systemic corticosteroid medications. The diagnosis is made on the basis of the presence of a painful, palpable defect in the substance of the tendon; an inability to completely extend the knee against gravity; and the existence of patella alta confirmed by lateral radiographs. Ultrasonography and magnetic resonance imaging are useful in identifying a neglected rupture, as well as when the diagnosis is in question or an intra-articular injury is suspected. The prognosis after a patellar tendon rupture depends in large part on the interval between injury and repair. Surgery soon after the injury is recommended for optimal results. This is best accomplished by accurate reapproximation of the ruptured tendon ends, repair of the torn extensor retinacula, and placement of a reinforcing cerclage suture. An aggressive rehabilitation program, emphasizing early range-of-motion exercises, protected weight bearing, and quadriceps strengthening, will enhance the results of surgery. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished.     

Repair of Quadriceps and Patellar Tendon Tears

Tears of the quadriceps or patellar tendon usually occur after a sudden eabccentric contraction and are diagnosed by a palpable gap at the injury site combined with an inability to perform a straight leg raise. Bilateral knee radiographs may demonstrate patella alta with patellar tendon tears and patella baja with quadriceps tendon tears compared with the uninjured knee. Ultrasound and magnetic resonance imaging can be helpful when there is uncertainty in the diagnosis. Surgical treatment is indicated for complete tears and some high-grade, partial tears. Nonabsorbable high-strength sutures or suture tape are placed in running locking fashion along the injured tendon and secured to the patella with bone tunnels (i.e., transosseous) or suture anchors. The transosseous technique requires exposure of the length of the patella to drill 3 bone tunnels to shuttle the sutures and tie over either pole of the patella. The suture anchor technique allows for a smaller incision and less soft-tissue dissection and may use a knotted or knotless technique. Biomechanical testing with load to failure is not statistically different between the transosseous and anchor techniques, although anchors have been shown to have less gap formation at the repair site. Repair augmentation with a graft may be beneficial in mid-substance injuries, chronic tears, and in cases of compromised tissue quality. Rehabilitation usually can be initiated immediately with protected weight-bearing in an orthosis, safe-zone knee passive range of motion, and avoidance of active extension. After a period of 6 weeks, rehabilitation can progress with full range of motion and a concentric strengthening program.     

Chronic rupture of a patellar tendon: A technique for reconstruction with achilles allograft

Chronic ruptures of the patellar tendon fortunately are an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by quadriceps muscle contracture and a great deal of scar tissue formation. We report the case of a repair of a chronic patellar tendon rupture. The patient's right patellar tendon was reconstructed approximately 10 months after the injury using quadricepsplasty and an Achilles tendon allograft with a suprapatellar wire for tension release. Four weeks postoperatively, he had attained 60° of flexion and full active extension. At 8 weeks, the suprapatellar wire was removed allowing the distribution of stresses on the reconstructed patellar tendon. At 6 months, the patient had 130° of flexion and full extension, but showed a persistent 40% deficit in right quad strength. The technique accomplished the preoperative goals of restoring quadriceps function, restoring the anatomic position of the patella, and allowing early mobilization after surgery. Although the use of a suprapatellar wire to reduce tension on the reconstructed tendon required a second operation for removal, it allowed early mobilization and better healing of the repair.     

Transpatellare Refixation der frischen patellanahen Quadrizepssehnenruptur mittels FiberWire®

OBJECTIVE: Reconstruction of the extensor mechanism of the knee joint by stable suture of the quadriceps tendon. Early functional treatment. INDICATIONS: Acute or partial disruption of the quadriceps tendon close to the proximal patella pole with loss of extensor function of the knee joint. CONTRAINDICATIONS: Open rupture of the quadriceps tendon with extended soft-tissue damage and high risk of or ongoing inflammation until healing of the soft tissues. Chronic quadriceps tendon rupture. Ruptures at the musculotendinous junction. SURGICAL TECHNIQUE: Supine positioning of the patient on a standard operating table with the knee in 30 degrees of flexion. Securing of the proximal tendon stump with two Bunnell sutures using no. 2 Fiber-Wire (Arthrex GmbH, Karlsfeld/Munich, Germany). Creation of a transverse, central trough in the superior pole of the patella. Transosseous refixation of the quadriceps tendon through longitudinal transpatellar drill holes. Intraoperative evaluation of the stability of the suture at 60 degrees of flexion. Repair of the retinacula with multiple interrupted sutures. POSTOPERATIVE MANAGEMENT: Partial weight bearing (15-25 kg) for 6 weeks. Knee orthesis for 6 weeks, with increase of the initially allowed flexion of 30 degrees every 2 weeks by another 30 degrees . Initially, continuous passive motion (CPM) and passive movement exercises up to 60 degrees of flexion. After discharge from hospital, outpatient physical therapy with prone active flexion exercises. At the beginning of the 5th week, start with active and passive extension of the knee joint. From the 7th week on, full weight bearing is allowed and coordinative and strengthening exercises should be commenced. Sport activities can gradually be taken up after 3 months. RESULTS: Early diagnosis, timely surgical repair and early functional treatment are important for the outcome of quadriceps tendon ruptures. With the presented method, ruptures close to the upper patella pole can be treated. The majority of quadriceps tendon ruptures takes place in this area since the avascular zone found here predisposes to degenerative changes.