自体半腱肌肌腱重建膝内侧副韧带浅层的临床应用

目的分析自体半腱肌肌腱重建膝内侧副韧带浅层治疗陈旧性膝内侧副韧带Ⅲ度损伤的临床疗效。 方法回顾性研究十堰市太和医院骨1科自2013年4月至2016年4月收治的28例陈旧性Ⅲ度膝关节内侧副韧带损伤的患者，新鲜断裂的内侧副韧带、Ⅰ度和Ⅱ度损伤患者排除。术前应力位拍X片检查可见膝关节内侧间隙较健侧>5 mm，磁共振检查可见膝关节内侧副韧带皱缩或断裂。手术方法为取自体同侧的半腱肌，编织缝合，编织好的肌腱从胫骨的内侧脊前方穿入，从脊的后方穿出。然后将肌腱的两个尾端用导引针穿入股骨隧道，可吸收界面螺钉固定。术后在可调支具保护下行膝关节功能锻炼，术后随访12个月左右，拍摄膝关节内侧应力位片、应用Lyshlom评分、国际膝关节文献委员会膝关节评估表(IKDC)评分评判采用配对t检验分析比较。 结果患者术后Lyshlom评分(t＝7.449)、IKDC评分(t＝8.915)、膝内侧应力位片开口距离与健侧距离的差值(t＝5.014)均改善，术前术后差异有统计学意义(均为P<0.05)。 结论应用自体半腱肌肌腱重建膝内侧副韧带浅层对治疗膝内侧副韧带陈旧性损伤短期临床效果显著。

Reconstruction of superficial medial collateral ligament of knee with autogenous semitendinosus tendon

ObjectiveTo evaluate the clinical effect of the superficial medial collateral ligament (MCL) reconstruction with autogenous semitendinosus tendon in the treatment of the Ⅲ degree chronic medial collateral ligament injury. MethodsA retrospective study was carried out on 28 patients with Ⅲ degree medial collateral ligament injury in Shiyan Taihe Hospital from April 2013 to April 2016. Before operation, stress radiography showed medial knee gap>5 mm compared with the contralatral knee; MRI examination showed the MCL crimping or broken. The operation method was taking ipsilateral autologous semitendinosus tendon and braided suturing the two ends. The sutured tendon penetrated from the anterior drilling hole of the tibia out from the posteromedial drilling hole, then using the guide pin taking the two ends of the tendon through the femoral tunnel and the two ends were fixed by absorbable screws. After operation, the knee function exercises were performed under the adjustable orthosis protection. The patients were followed up for 12 months or so. The stress radiography of medial side of knee, the Lyshlom score and IKDC score were used to evaluate the curative effect by paired t-test. ResultsThe differences of Lyshlom score (t=7.449), IKDC score(t=8.915), and the distance between the medial stress slice and the healthy side of the patients(t=5.014) were all statistically significant (all P<0.05). ConclusionThe reconstruction of the superficial medial collateral ligament with autogenous semitendinosus tendon is effective in the treatment of the chronic injury of the medial collateral ligament.