LARS人工韧带重建治疗陈旧性髌韧带断裂的疗效研究
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摘要
目的探讨LARS人工韧带重建治疗陈旧性髌韧带断裂的疗效。方法回顾分析2011年12月—2017年12月收治并符合选择标准的12例陈旧性髌韧带断裂患者临床资料,患者均采用LARS人工韧带重建治疗。男8例,女4例;年龄18～55岁,平均33.5岁。致伤原因:交通事故伤4例,运动伤5例,暴力伤3例。左膝5例,右膝7例。病程2～12周,平均2.5周。术前膝关节Lysholm评分为(43.2±3.2)分,Kujala评分为(43.9±2.6)分,膝关节活动度为(106.5±14.7)°,髌上10 cm处大腿周径为(40.92±1.93)cm。影像学检查示髌韧带体部断裂4例,髌骨下极处断裂1例,胫骨结节止点处断裂7例;Caton-Deschamps指数为1.47±0.13。结果所有患者术后均获随访,随访时间12～30个月,平均20.5个月。切口均Ⅰ期愈合,无感染、韧带再断裂以及神经血管损伤等并发症发生。术后1年,患者膝关节活动度为(131.0±10.2)°,Lysholm评分为(87.4±2.4)分,Kujala评分为(88.3±4.8)分,髌上10 cm处大腿周径为(42.58±1.93)cm,与术前比较差异均有统计学意义(P<0.05)。按Insall评定标准评价疗效,获优9例、良3例。影像学复查示Caton-Deschamps指数为1.09±0.11,较术前明显降低(t=8.155,P=0.000)。结论 LARS人工韧带重建治疗陈旧性髌韧带断裂疗效确切,能够有效修复伸膝装置及恢复膝关节功能。
Objective To explore the effectiveness of patellar tendon reconstruction by using LARS artificial ligament in treatment of old patellar tendon rupture. Methods A clinical data of 12 patients with old patellar ligament ruptures, who met the inclusive criteria and reconstructed with LARS artificial ligament between December 2011 and December 2017, was retrospectively analyzed. There were 8 males and 4 females with an average age of 33.5 years(range,18-55 years). The cause of injury included traffic accident injury in 4 cases, sport injury in 5 cases, and violent injury in3 cases. There were 5 cases in the left knee and 7 cases in the right knee. The disease duration was 2-12 weeks(mean, 2.5 weeks). The preoperative Lysholm score and Kujala score were 43.2±3.2 and 43.9±2.6, respectively. The knee range of motion was(106.5±14.7)°. The thigh circumference which was measured at 10 cm above the upper end of the patella was(40.92±1.93) cm. There were 4 cases of patellar ligament body rupture, 1 case of patella distal pola rupture, and 7 cases of tibial tuberosity attachment rupture. Preoperative Caton-Deschamps index was 1.47±0.13. Results All patients were followed up 12-30 months(mean, 20.5 months). All incisions healed by first intention. And no complication such as infection, recurrent rupture, and neurovascular injury occurred. At 1 year after operation, the knee range of motion was(131.0±10.2)°, Lysholm score was 87.4±2.4, Kujala score was 88.3±4.8, the thigh circumference which was measured at10 cm above the upper end of the patella was(42.58±1.93) cm; all showing significant differences when compared with preoperative values(P<0.05). The effectiveness results were excellent in 9 cases and good in 3 cases according to the Insall evaluation criteria. The Caton-Deschamps index was 1.09±0.11, which was significantly lower than preoperative one(t=8.155, P=0.000). Conclusion Patellar tendon reconstruction with LARS artificial ligament is an effective method for the old patellar ligament rupture, which can effectively repair the knee extension device and restore knee function.
Objective To explore the effectiveness of patellar tendon reconstruction by using LARS artificial ligament in treatment of old patellar tendon rupture. Methods A clinical data of 12 patients with old patellar ligament ruptures, who met the inclusive criteria and reconstructed with LARS artificial ligament between December 2011 and December 2017, was retrospectively analyzed. There were 8 males and 4 females with an average age of 33.5 years(range,18-55 years). The cause of injury included traffic accident injury in 4 cases, sport injury in 5 cases, and violent injury in3 cases. There were 5 cases in the left knee and 7 cases in the right knee. The disease duration was 2-12 weeks(mean, 2.5 weeks). The preoperative Lysholm score and Kujala score were 43.2±3.2 and 43.9±2.6, respectively. The knee range of motion was(106.5±14.7)°. The thigh circumference which was measured at 10 cm above the upper end of the patella was(40.92±1.93) cm. There were 4 cases of patellar ligament body rupture, 1 case of patella distal pola rupture, and 7 cases of tibial tuberosity attachment rupture. Preoperative Caton-Deschamps index was 1.47±0.13. Results All patients were followed up 12-30 months(mean, 20.5 months). All incisions healed by first intention. And no complication such as infection, recurrent rupture, and neurovascular injury occurred. At 1 year after operation, the knee range of motion was(131.0±10.2)°, Lysholm score was 87.4±2.4, Kujala score was 88.3±4.8, the thigh circumference which was measured at10 cm above the upper end of the patella was(42.58±1.93) cm; all showing significant differences when compared with preoperative values(P<0.05). The effectiveness results were excellent in 9 cases and good in 3 cases according to the Insall evaluation criteria. The Caton-Deschamps index was 1.09±0.11, which was significantly lower than preoperative one(t=8.155, P=0.000). Conclusion Patellar tendon reconstruction with LARS artificial ligament is an effective method for the old patellar ligament rupture, which can effectively repair the knee extension device and restore knee function.
引文
1 Ramsey RH, Muller GE. Quadriceps tendon rupture:a diagnostic trap. Clin Orthop Relat Res, 1970, 70(5-6):161-164.
2 Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg(Am), 1981, 63(6):932-937.
3 Spector ED, DiMarcangelo MT, Jacoby JH. The radiologic diagnosis of quadriceps tendon rupture. N J Med, 1995, 92(9):590-592.
4 O'Malley M, Reardon P, Pareek A, et al. Extensor mechanism disruption in knee dislocation. J Knee Surg, 2016,29(4):293-299.
5 Harato K, Kobayashi S, Udagawa K, et al. Surgical technique to bring down the patellar height and to reconstruct the tendon for chronic patellar tendon rupture. Arthroscopy Techniques, 2017,6(5):e1897-e1901.
6 Ode GE, Piasecki DP, Habet NA, et al. Cortical button fixation:A better patellar tendon repair? Am J Sports Med, 2016, 44(10):2622-2628.
7 Ettinger M, Dratzidis A, Hurschler C, et al. Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures:a cadaveric study. Am J Sports Med, 2013, 41(11):2540-2544.
8 Temponi EF, Camelo N, Tuteja S, et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8):2468-2473.
9 Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions:two case reports. Knee,2012,19(4):508-512.
10 Abdou YE. Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft. Arch OrthopTrauma Surg, 2014,134(12):1717-1721.
11 Isiklar ZU, Varner KE, Lindsey RW, et al. Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res, 1996,(322):174-178.
12 Gilmore JH, Clayton-Smith ZJ, Aguilar M, et al. Reconstruction techniques and clinical results of patellar tendon ruptures:Evidence today. Knee, 2015,22(3):148-155.
13 Mittal R, Singh DP, Kapoor A. Neglected patellar tendon rupture:Preserve the fat pad. Orthopedics, 2011, 34(2):134.
14 Meyer Z, Ricci WM. Knee extensor mechanism repairs:Standard suture repair and novel augmentation technique. J Orthop Trauma,2016,30 Suppl 2:S30-S31.
15 Biedert RM, Tscholl PM. Patella alta:a comprehensive review of current knowledge. Am J Orthop(Belle Mead NJ), 2017, 46(6):290-300.
16 Maffulli N, Buono AD, Oliva F. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures:surgical technique. Muscles Ligaments Tendons J, 2017, 7(1):157-162.
17 Talia AJ, Tran P. Bilateral patellar tendon reconstruction using LARS ligaments:case report and review of the literature. BMC Musculoskeletal Disorders, 2016,17(6):302.
18 Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament:surgical technique and case report. Strategies Trauma Limb Reconstr, 2011, 6(1):39-41.
19 Ranger P, Senay A, Gratton GR, et al. LARS synthetic ligaments for the acute management of 111 acute knee dislocation:effective surgical treatment for most ligaments. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12):3673-3681.
20 Bonnin M, Lustig S, Huten D. Extensor tendon ruptures after total knee arthroplasty. Orthop Traumatol Surg Res, 2016,102(1 Suppl):S21-S31.
2 Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg(Am), 1981, 63(6):932-937.
3 Spector ED, DiMarcangelo MT, Jacoby JH. The radiologic diagnosis of quadriceps tendon rupture. N J Med, 1995, 92(9):590-592.
4 O'Malley M, Reardon P, Pareek A, et al. Extensor mechanism disruption in knee dislocation. J Knee Surg, 2016,29(4):293-299.
5 Harato K, Kobayashi S, Udagawa K, et al. Surgical technique to bring down the patellar height and to reconstruct the tendon for chronic patellar tendon rupture. Arthroscopy Techniques, 2017,6(5):e1897-e1901.
6 Ode GE, Piasecki DP, Habet NA, et al. Cortical button fixation:A better patellar tendon repair? Am J Sports Med, 2016, 44(10):2622-2628.
7 Ettinger M, Dratzidis A, Hurschler C, et al. Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures:a cadaveric study. Am J Sports Med, 2013, 41(11):2540-2544.
8 Temponi EF, Camelo N, Tuteja S, et al. Reconstruction of chronic patellar tendon rupture with contralateral bone-tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8):2468-2473.
9 Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions:two case reports. Knee,2012,19(4):508-512.
10 Abdou YE. Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft. Arch OrthopTrauma Surg, 2014,134(12):1717-1721.
11 Isiklar ZU, Varner KE, Lindsey RW, et al. Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res, 1996,(322):174-178.
12 Gilmore JH, Clayton-Smith ZJ, Aguilar M, et al. Reconstruction techniques and clinical results of patellar tendon ruptures:Evidence today. Knee, 2015,22(3):148-155.
13 Mittal R, Singh DP, Kapoor A. Neglected patellar tendon rupture:Preserve the fat pad. Orthopedics, 2011, 34(2):134.
14 Meyer Z, Ricci WM. Knee extensor mechanism repairs:Standard suture repair and novel augmentation technique. J Orthop Trauma,2016,30 Suppl 2:S30-S31.
15 Biedert RM, Tscholl PM. Patella alta:a comprehensive review of current knowledge. Am J Orthop(Belle Mead NJ), 2017, 46(6):290-300.
16 Maffulli N, Buono AD, Oliva F. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures:surgical technique. Muscles Ligaments Tendons J, 2017, 7(1):157-162.
17 Talia AJ, Tran P. Bilateral patellar tendon reconstruction using LARS ligaments:case report and review of the literature. BMC Musculoskeletal Disorders, 2016,17(6):302.
18 Naim S, Gougoulias N, Griffiths D. Patellar tendon reconstruction using LARS ligament:surgical technique and case report. Strategies Trauma Limb Reconstr, 2011, 6(1):39-41.
19 Ranger P, Senay A, Gratton GR, et al. LARS synthetic ligaments for the acute management of 111 acute knee dislocation:effective surgical treatment for most ligaments. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12):3673-3681.
20 Bonnin M, Lustig S, Huten D. Extensor tendon ruptures after total knee arthroplasty. Orthop Traumatol Surg Res, 2016,102(1 Suppl):S21-S31.