陈旧性内侧副韧带损伤的袢板腓骨长肌腱重建术

Combined reconstructions with a half peroneal longus tendon autograft for old medial collateral ligament injuries

摘要:

[目的] 介绍陈旧性内侧副韧带 (medial collateral ligament, MCL) 损伤的腓骨长肌腱同时重建内侧副韧带浅层 (su- perficial MCL, sMCL)和后斜韧带(posterior oblique ligament, POL)的手术技术及初步临床效果。[方法]14 例陈旧性 MCL 损伤的患者行腓骨长肌腱同时重建 sMCL 和 POL。取自体腓骨长肌腱的前半部分做为移植物，分别建立股骨侧骨道和胫骨侧骨道。 将移植腱对折后拉入股骨骨洞内，使用袢板在股骨外侧固定。将较短的游离端和较长的游离端分别拉入 sMCL 和 POL 胫骨骨侧的两隧道，拉紧移植物，两个移植物引线打结固定，再加外排钉固定。[结果]本组 14 例患者，除 1 例外，其余均获随访 6~26 个月，平均(12.57±6.04)个月。末次随访时，Lysholm 评分、IKDC 评分、VAS 评分均较术前明显改善(P＜0.05)。影像方面，术后外翻应力伸直 0°位和屈曲 30°位内侧间隙较术前均显著变小(P＜0.05)。[结论]腓骨长肌腱同时重建 sMCL 和 POL 治疗陈旧性 MCL 损伤能恢复膝关节稳定性，显著改善膝关节功能。具有切口小、术后恢复快、患者满意度高的优点。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of simultaneous superficial medial collat- eral ligament (sMCL) and posterior oblique ligament (POL) reconstructions with a half peroneal tendon autograft for old medial collateral lig- ament (MCL) injuries. [Methods] A total of 14 patients had sMCL and POL reconstructed simultaneously with a half peroneal longus ten- don autograft. The anterior half of the peroneal longus tendon was harvested to prepare the graft. After establishing the femoral and tibial bone tunnels respectively, the graft was folded, pulled into the femoral tunnel and fixed with a loop plate. The shorter and longer free ends were pulled into the tibial tunnels of sMCL and POL respectively, and tightened. The two end sutures were tied and enhanced by external row screws. [Results] All the 14 patients were followed up for 6~26 months, with an average of (12.57±6.04) months, except 1 patient. At the latest follow-up, the Lysholm, IKDC and VAS scores were significantly improved compared with those preoperatively (P＜0.05) . Radio- graphically, the inner joint space at 0°and 30° flexion under valgus stress significantly decreased postoperatively compared with those pre- operatively (P＜0.05) . [Conclusion] Simultaneous sMCL and POL reconstructions with a half peroneal tendon autograft does restore the sta- bility of knee joint and considerably improve the function of the knee joint for old MCL injuries, with advantages of small incision, quick postoperative recovery and high patient satisfaction.