锚钉缝合术修复治疗副韧带前束撕脱的疗效

doi:10.3877/cma.j.issn.1674-134X.2020.04.017

目的

评价锚钉缝合术对于全膝关节置换术(TKA)术中膝关节内侧副韧带(MCL)前束撕脱屈膝位不稳的临床效果。

方法

回顾性分析了2011年1月至2017年12月在东莞市中西医结合医院骨科接受TKA的患者3 922例，确定术中MCL前束撕脱屈膝位不稳的病例48例(1.2%)，所有患者接受锚钉缝合术。所有患者在术后6周内使用铰链式护膝，术后每次随访时，测量膝关节的运动范围。在术后6周、3个月、1年，及之后每年接受1次X线检查，以评估美国特种外科医院(HSS)膝关节评分，并以t检验行统计学分析。

结果

在3 922例全膝关节置换术中，48例(1.2%)发生术中MCL损伤。其中，1例患者术后两年内死亡，2例患者失访，共有45例患者纳入了本研究。其中24例MCL中段撕裂，21例MCL附着点断裂。35例发生在十字韧带保留的TKA术中和10例发生在后稳定型TKA术中。患者末次随访时最大屈膝(111.2±18.8)°、最大伸膝(1.5±1.5)°以及活动范围(110.2±30.2)°明显高于治疗前(107.5±22.5)°、(5.5±4.5)°、(102.2±27.8)°(t ＝ 2.822、5.026、3.670，均为P<0.05)。平均随访时间(99.2±5.7)个月，没有1例患者发生膝关节不稳定。其中5例患者因为膝关节僵硬而接受了干预(4例手法推拿和1例翻修术)，2例患者因为人工膝关节无菌性松动接受了翻修术。

结论

TKA术中MCL前束撕脱可以通过锚钉缝合术修复治疗，然后进行铰链式护膝支撑。膝关节僵硬是一种常见的并发症。

关键词: 关节成形术, 置换, 膝, 内侧副韧带, 膝, 缝合锚

Objective

To evaluate the clinical effect of anchor suture on anterior MCL anterior bundle avulsion and knee instability during TKA operation.

Methods

A retrospective analysis of 3 922 patients who received TKA in the Department of Orthopaedics, Department of Orthopedics, Dongguan Hospital from January 2011 to December 2017 was performed, and 48 cases (1.2%) of MCL anterior bundle avulsion and knee instability were determined during operation All the patients underwent anchor suture. All the patients used hinged knee braces within six weeks after surgery. At each follow-up visit, the range of motion of the knee joint was measured. X-ray examination was performed at six weeks, three months, and one year after the surgery (then once a year) to evaluate the HSS knee score. The results were analyzed by t test.

Results

In 3 922 cases of total knee arthroplasty, 48 cases (1.2%) had intraoperative MCL injury. Among them, one patient died within two years after the operation, two patients were lost for follow-up. A total of 45 patients were included. Among them, MCLs of 24 cases were torn, and MCLs of 21 cases were broken. Thirty-five cases occurred in TKA with cruciate ligament retention and 10 cases occurred in post-stable TKA. At the last follow-up, the maximum knee flexion (111.2±18.8) °, maximum knee extension (1.5±1.5) °, and range of motion (110.2±30.2) ° were all significantly higher than those before the treatment [ (107.5±22.5) °, (5.5±4.5) °, (102.2±27.8) °] (t =2.822, 5.026, 3.670, all P <0.05). The average follow-up time was (99.2±5.7) months. None of the patient had knee instability. Five patients received intervention for stiff knees (four manual manipulations and one revision), and two patients received revision for aseptic loosening of the artificial knee.

Conclusions

MCL anterior bundle avulsion can be repaired and treated by anchor suture during TKA, and then hinged knee brace is applied. Knee stiffness is a common complication.

Key words: Arthroplasty, replacement, knee, Medial collateral ligament, knee, Suture anchors

图4 术后缝合

表2 手术前后患者膝关节活动范围比较[n＝45，°，(± s)]

时间	最大屈膝	最大伸膝	活动范围
术前	107.5±22.5	5.5±4.5	102.2±27.8
末次随访	111.2±18.8	1.5±1.5	110.2±30.2
t值	2.822	5.026	3.670
P值	<0.05	<0.01	<0.01

表2 手术前后患者膝关节活动范围比较[n＝45，°，(± s)]

时间	最大屈膝	最大伸膝	活动范围
术前	107.5±22.5	5.5±4.5	102.2±27.8
末次随访	111.2±18.8	1.5±1.5	110.2±30.2
t值	2.822	5.026	3.670
P值	<0.05	<0.01	<0.01

表3 患者末次随访HSS评分(± s)

		例数	HSS评分	t值	P值
总体		45	85.5±1.4	-	-
年龄(岁)
	<65	25	87.3±1.1	0.133	>0.05
	≥65	20	83.2±2.5	0.133	>0.05
性别
	男	7	89.5±1.0	0.791	>0.05
	女	38	84.7±2.5	0.791	>0.05
BMI(kg/m²)
	<40	34	86.3±1.0	0.305	>0.05
	≥40	11	82.2±2.1	0.305	>0.05
术前膝关节冠状面角度
	内翻/中性	37	87.3±1.1	0.580	>0.05
	外翻	8	74.3±1.0	0.580	>0.05
术前活动范围(°)
	<100	17	83.6±1.1	0.648	>0.05
	≥100	28	86.3±1.2	0.648	>0.05
术前HSS评分
	<47	24	81.2±1.5	1.642	>0.05
	≥47	21	89.2±1.3	1.642	>0.05
MCL损伤
	MCL中段撕裂	24	88.6±1.0	0.824	>0.05
	MCL附着点断裂	24	82.3±1.9	0.824	>0.05
TKA类型
	十字韧带保留型	35	85.3±1.6	0.264	>0.05
	后稳定型	10	86.2±1.5	0.264	>0.05

表3 患者末次随访HSS评分(± s)

		例数	HSS评分	t值	P值
总体		45	85.5±1.4	-	-
年龄(岁)
	<65	25	87.3±1.1	0.133	>0.05
	≥65	20	83.2±2.5	0.133	>0.05
性别
	男	7	89.5±1.0	0.791	>0.05
	女	38	84.7±2.5	0.791	>0.05
BMI(kg/m²)
	<40	34	86.3±1.0	0.305	>0.05
	≥40	11	82.2±2.1	0.305	>0.05
术前膝关节冠状面角度
	内翻/中性	37	87.3±1.1	0.580	>0.05
	外翻	8	74.3±1.0	0.580	>0.05
术前活动范围(°)
	<100	17	83.6±1.1	0.648	>0.05
	≥100	28	86.3±1.2	0.648	>0.05
术前HSS评分
	<47	24	81.2±1.5	1.642	>0.05
	≥47	21	89.2±1.3	1.642	>0.05
MCL损伤
	MCL中段撕裂	24	88.6±1.0	0.824	>0.05
	MCL附着点断裂	24	82.3±1.9	0.824	>0.05
TKA类型
	十字韧带保留型	35	85.3±1.6	0.264	>0.05
	后稳定型	10	86.2±1.5	0.264	>0.05

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Efficacy of anchor suture on anterior bundle avulsion of meidal collateral ligament

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Efficacy of anchor suture on anterior bundle avulsion of meidal collateral ligament