摘要
目的采用股二头肌长头腱重建膝关节后外侧角韧带结构并探讨其近期临床效果。方法对23例膝关节后外侧角韧带结构陈旧性损伤患者,采用股二头肌长头腱进行解剖学重建。术中保留股二头肌长头在腓骨头的附着或者在远端的连接,分切出一个远端带蒂、宽8～10mm、长16～18cm的肌腱条,再将肌腱条纵行劈为前、后两半。将后侧半肌腱条反折重建腓韧带和肌腱,其股骨附着点位于肌腱的解剖学附着点,反折后的游离端固定在开口于胫骨平台后外侧角的骨隧道内。将前侧半肌腱条反折重建外侧副韧带,其股骨附着点位于外侧副韧带的解剖学附着点,反折后的游离端固定在开口于腓骨头前缘的骨隧道内,或者直接缝合在腓骨头上。通过对膝关节内翻稳定性和小腿外旋活动度的随访,了解膝关节后外侧角的稳定性。结果术后半年,完全伸膝位无膝内翻不稳;屈膝30°,Ⅰ度膝内翻不稳伴硬性终止点2例;屈膝30°,小腿外旋增加2例,相同16例,减小5例。术后1年,患膝后外侧角的稳定性无明显改变。结论采用股二头肌长头腱同时重建膝外侧副韧带、腓韧带和肌腱能够有效恢复膝关节后外侧角的稳定性。
Objective To introduce the method of knee posterolateral complex reconstruction with the long head of biceps femoris tendon, and to evaluate the short-term outcomes. Methods Anatomic reconstruction of the chronic posterolateral complex injury of knee joint in 23 cases, were performed with the long head of the biceps femoris tendon from February 2001 to November 2002. All of the patients complained of knee instability with abnormal gait, all of which were associated with other knee ligament injury. With retention of the distal attachment or insertion of the long head of the biceps femoris tendon, a distally pedicled tendon slip was made 8-10 mm of width and 16-18 cm of length. Then the tendon slip was divided longitudinally into halves. The posterior half was folded to reconstruct the popliteofibular ligament and popliteal tendon, with the femoral insertion at the anatomical attachment site of the popliteal tendon, the free end fixed into the tunnel at the posterolateral corner of the tibial plateau. The anterior half was folded to reconstruct the lateral collateral ligament, with the femoral insertion at the anatomical attachment site of the lateral collateral ligament, and the free end fixed into the tunnel or sutured to the fibular head. Results The posterolateral stability of the knee was evaluated in more than 6 months follow-up, mainly through examination of knee varus instability and leg external rotation range. 6 months after operation, there was no varus knee instability in full extension. At 30° flexion, one-grade varus instability was found in 2, but with firm endpoint, no varus instability was found in other cases; external rotation increased in 2, remained the same in 16, and decreased in 5 compared with the healthy side. One year after operation, the stability of the posterolateral corner of the knee had no change compared with that of the 6 months examination. Conclusion Simultaneous reconstruction of knee lateral collateral ligament, popliteofibular ligament, and popliteal tendon with the long head of biceps femoris tendon is effective to restore posterolateral stability of the knee joint.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第3期141-145,共5页
Chinese Journal of Orthopaedics
