同种异体跟腱移植物重建内侧副韧带浅层结构治疗膝关节外翻不稳定的临床研究

目的:评估采用同种异体跟腱重建内侧副韧带(MCL)浅层结构对恢复膝关节外翻稳定性的早期临床疗效。方法:回顾性分析2005年8月至2010年12月我科收治的诊断为陈旧膝关节内侧副韧带损伤并符合重建手术指征的患者19例,均采用同种异体跟腱作为移植物。患者入选标准为:1)陈旧MCL损伤,受伤至手术时间超过3周;2)IKDC膝关节外翻不稳定分级为C级内侧关节间隙开口程度(侧侧差值)为6～10 mm]或D级(内侧关节间隙开口程度大于10 mm);3)随访时间至少12个月。术前、术后采用Telos装置拍摄膝关节外翻位应力像评估内侧结构稳定性。其他评价指标包括IKDC主观功能评分和Lysholm主观功能评分。结果:19例患者中,16例获得随访,其中男性12例,女性4例;平均年龄31.8岁(19～53岁),受伤至手术时间平均17.6个月(24天～84个月),随访时间平均27.8个月(12～67个月)。患者术前膝关节内侧间隙开口程度平均为(8.9±3.1)mm(6～23.2 mm),术后平均(0.1±1.4)mm(-2～2.4 mm),手术前后比较差异有统计学意义(P<0.05)。IKDC主观功能评分术前平均(49.8±6.7)分(31～57.5分),术后平均(82.8±4.8)分(71.3～93.1分),手术前后比较差异有统计学意义。Lysholm评分术前平均(69.3±5.7)分(55～78分),术后平均(88.3±4.6)分(75～95分),手术前后比较差异有统计学意义。16例患者中,术前膝关节外翻稳定性IKDC分级C级12例,D级4例;术后A级14例,B级2例。结论:采用同种异体跟腱重建内侧副韧带浅层结构能够显著改善膝关节外翻稳定性,术后平均2年的随访表明患者主观功能评分满意。

Surgical Treatment for Valgus Instability of Knee through Superficial Medial Collateral Ligament Reconstruction Using Achilles Allograft

Objective To evaluate the early outcome of superficial medial collateral ligament(sMCL)reconstruction using Achilles allografts in patients with knee valgus instability.Methods From August 2005 to December 2010,19 consecutive patients diagnosed as medial collateral ligament(MCL) injury and received sMCL reconstruction using Achilles allografts were included in this study according to the following inclusion criteria:1)chronic MCL injury,duration from initial injury to surgery more than 3 weeks.2)International Knee Documentation Committee(IKDC) grade C or D valgus instability.3)at least 12 months follow-up period after surgery.The valgus stress radiographs were used for evaluation of the stability of MCL both preoperatively and postoperatively.Other assessment included IKDC subjective functional evaluation and Lysholm score estimation.Results 16 of the 19 patients including 12 males and 4 females received final follow-up.Their median age was 32 years(range,19～53).The average duration from injury to surgery was 17.6 months(24 days to 84 months),and median follow-up period was 27.8 months(range,12～67).The medial side knee instability detected by stress radiographs was 8.9±3.1 mm(6～23.2 mm,side-to-side difference)preoperatively and 0.1±1.4 mm(-2～2.4 mm,side-to-side difference) postoperatively with significant statistical difference.The average IKDC subjective knee functional score was 49.8(31～57.5) preoperatively and 82.8(71.3～93.1) postoperatively(P<0.05).The Lysholm score was 69.3(55～78) preoperatively and 88.3(75～95) postoperatively(P<0.05).For the evaluation of the medial side instability,there were 12 cases IKDC grade C and 4 cases grade D preoperatively,and 14 cases grade A and 2 cases grade B postoperatively.Conclusion The valgus stability of knee could be effectively corrected with the reconstruction of superficial medial collateral ligament using Achilles allograft.The subjective functional score of all the patients improved significantly.