非止血带下改良髌骨穿孔结合锚钉修复急性股四头肌腱骨腱结合部断裂

发布时间：2018-01-23 21:21

本文关键词： 股四头肌腱断裂内侧髌股韧带髌股关节缝线锚钉髌骨穿孔技术　出处：《中国修复重建外科杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的探讨采用非止血带下改良髌骨穿孔结合锚钉修复急性股四头肌腱骨腱结合部断裂的疗效。方法 2010年6月—2016年6月,采用非止血带下改良髌骨穿孔结合锚钉技术修复15例急性股四头肌腱骨腱结合部断裂。男14例,女1例;年龄19~74岁,平均44岁。致伤原因:运动伤7例,扭伤5例,暴力伤3例。病程3 h~3 d,中位病程2 d。左侧6例,右侧9例。均为闭合性损伤。患者既往无肢体功能障碍后遗症、无肢体关节手术史。术后随访复查膝关节正侧位及髌骨轴位X线片;采用Lysholm评分和Kujala评分系统评价膝关节功能。结果手术时间50~60 min,平均55 min。术中出血量50~150 mL,平均87 mL。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12~24个月,平均18个月。术后膝关节功能恢复良好,术后1年膝关节Lysholm评分为92~96分,平均94分;髌股关节Kujala评分为90~95分,平均93分。随访期间无股四头肌腱再断裂及锚钉松动发生。术后1年膝关节侧位及髌骨轴位片测量,髌骨深度指数3.62~4.09,平均3.84;滑车深度指数4.45~6.50,平均5.56;滑车面角137~145°,平均142°;Insall-Salvati指数0.90~1.18,平均1.06。术后1年外侧髌股角较术前增大,髌骨倾斜角及髌骨外移度均较术前减小,比较差异均有统计学意义(P0.05)。结论非止血带下改良髌骨穿孔结合锚钉技术修复急性股四头肌腱骨腱结合部断裂,能更好地重建稳定髌股关节,增加肌腱固定强度,有效均匀地分散应力,增加腱骨愈合面积。
[Abstract]:Objective to investigate the effect of modified patellar perforation combined with anchor nail under non-tourniquet for the repair of acute fracture of quadriceps femoris tendon bone and tendon. Methods from June 2010 to June 2016. Modified patellar perforation under non-tourniquet combined with anchor nail technique was used to repair 15 cases of acute fracture of tendon joint of quadriceps femoris (14 male and 1 female). The age was 1974 years (mean 44 years). The causes of injury were sports injury (7 cases), sprain (5 cases) and violence (3 cases). The course of disease was 3 days, the median course was 2 days and the left side was 6 cases. There were 9 cases on the right side with closed injury. The patients had no sequelae of limb dysfunction and had no history of joint operation. The X-ray films of the knee joint in the anteroposterior and lateral position of the knee joint and the axial position of the patella were followed up postoperatively. The function of knee joint was evaluated by Lysholm and Kujala scoring system. Results the operative time was 50 ~ 60 min (mean 55 min) and the intraoperative bleeding was 50 ~ 150 mL. The average was 87 mL 路L ~ (-1). The incision healed in the first stage and there were no related complications. All the patients were followed up for 12 ~ 24 months (mean 18 months). The knee joint function recovered well after operation. One year after operation, the Lysholm score of knee joint was 92 ~ 96 (mean 94). The Kujala score of patellofemoral joint was 90 ~ 95 (mean 93). There was no rerupture of quadriceps femoris tendon and loosening of anchor nail during follow-up. The patellar depth index was 3.62 ~ 4.09, with an average of 3.84; The depth index of the pulley was 4.45 ~ 6.50, with an average of 5.56; The angle of the surface of the pulley was 137 掳, with an average of 142 掳; The Insall-Salvati index was 0.90 ~ 1.18 (mean 1.06). The lateral patellofemoral angle increased and the patellar inclination angle and patellar outward displacement decreased one year after operation. Conclusion modified patellar perforation combined with anchor nail under non-tourniquet can repair the rupture of acute quadriceps tendon bone and tendon in order to reconstruct stable patellofemoral joint better. The strength of tendon fixation was increased, the stress was distributed uniformly and the healing area of tendon bone was increased.
【作者单位】：福建医科大学附属第二医院骨科;
【分类号】：R687.3
【正文快照】： 股四头肌腱断裂临床少见,可为跌倒、运动伤、暴力伤、锐器伤和全身代谢异常导致。修复此类损伤的手术方法有多种,但均存在一定不足[1-6]。急性股四头肌腱骨腱结合部断裂常合并内侧稳定结构破坏,尤其是内侧髌股韧带损伤。内侧髌股韧带是维持髌股关节稳定最重要的内侧稳定结构[7

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