全膝关节置换术后跟腱异体移植重建断裂髌骨肌腱一例

L. Crossett, R. Sinha, V. Franklin Sechriest, H. Rubash
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引用次数: 176

摘要

背景:全膝关节置换术后髌骨肌腱断裂是一种罕见且使人衰弱的并发症。正确的手术治疗仍有争议。本研究的目的是回顾全膝关节置换术后跟腱异体移植重建断裂髌骨肌腱的结果。方法:我们回顾了我们在9例全膝关节置换术后髌骨肌腱断裂患者中使用新鲜冷冻跟腱异体移植物和附着的跟骨移植物来恢复伸肌功能的经验(5例原发性和4例翻修)。所有患者在平均28个月时进行临床和影像学检查。结果:膝关节和功能评分分别由术前的26分和14分提高到术后的81分和53分。平均伸肌滞后从术前44°下降到术后3°,膝关节平均活动范围从88°增加到107°。术后早期2例移植物失败。两者都被成功修复。x线片显示平均髌骨近端移位17.8 mm,不影响伸肌功能。结论:这项短期随访研究表明,一旦跟腱同种异体移植物愈合,它可以作为全膝关节置换术后髌骨肌腱断裂的可靠重建。这项技术可能特别适合于伸肌机制因多次手术而受损的患者。需要继续随访以确定这些结果的长期持久性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reconstruction of a Ruptured Patellar Tendon with Achilles Tendon Allograft Following Total Knee Arthroplasty
Background: Rupture of the patellar tendon after total knee arthroplasty is a rare and debilitating complication. Proper surgical management of this condition remains controversial. The purpose of this study was to review the results of reconstruction of a ruptured patellar tendon with an Achilles tendon allograft following total knee arthroplasty.Methods: We reviewed our experience with the use of a fresh-frozen Achilles tendon allograft with an attached calcaneal bone graft to restore extensor function in nine patients with patellar tendon rupture following total knee arthroplasty (five primary and four revision). All patients were examined clinically and radiographically at an average of twenty-eight months.Results: The average knee and functional scores improved from 26 and 14 points, respectively, before the surgery to 81 and 53 points after the surgery. The average extensor lag decreased from 44° preoperatively to 3° postoperatively, and the average range of motion of the knee increased from 88° to 107°. Two grafts failed in the early postoperative period. Both were repaired successfully. Radiographs showed an average proximal patellar migration of 17.8 mm, which did not appear to affect extensor function.Conclusions: This short-term follow-up study showed that once an Achilles allograft has healed, it can serve as a reliable reconstruction of a ruptured patellar tendon following total knee arthroplasty. This technique may be particularly suited for patients in whom the extensor mechanism was compromised by multiple prior operations. Continued follow-up is necessary to determine the long-term durability of these results.
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