Missouri Bone and Joint Research Foundation, Missouri Bone and Joint Center, 1000 Des Peres Road, Suite 150, St Louis, MO 63131, USA.
Clin Orthop Relat Res. 2013 Jan;471(1):221-30. doi: 10.1007/s11999-012-2532-z.
Loss of the quadriceps tendon, patella, and patellar tendon leaves a major anterior defect that is difficult to close and compromises knee extension strength. Gastrocnemius muscle transfer does not sufficiently cover such major defects. This paper describes a new surgical technique that addresses these defects and the results of eight cases of revision TKA managed with this new technique.
The new procedure transfers the vastus medialis or the vastus lateralis and their tibial attachments or both muscles and their distal expansions combined with gastrocnemius and soleus flaps to cover major deficiencies in the anterior knee. Nine cadaver knee specimens were dissected to determine the effect of the transfer on nerve and blood supply of the muscles.
Eight patients underwent the new procedure between 2005 and 2009. Four knees had vastus medialis transfer, two vastus medialis and vastus lateralis transfer, two vastus medialis and medial gastrocnemius transfer, and two medial gastrocnemius and medial ½ of the soleus muscle transfer. Minimum followup was 15 months (mean, 43 months; range, 15-74 months). Patients were evaluated for anterior knee pain, quality of knee closure, ROM, extensor lag, walking ability, use of assistive devices, and ability to climb stairs with the operated extremity.
All patients achieved closure of the knee without synovial leaks by 10 days postoperatively. Mean flexion contracture at last followup was 3° (range, 0°-7°). Mean extension lag was 22° (range, 5°-65°). Extension lag was less in those knees that included gastrocnemius or soleus muscle transfer. None of the flaps developed necrosis.
The vastus medialis and vastus lateralis muscles provide adequate coverage for anterior soft tissue deficits of the knee.
股四头肌腱、髌骨和髌腱的丧失会导致前侧出现严重的缺损，难以闭合，并会影响膝关节的伸展力量。腓肠肌转移术无法充分覆盖如此大的缺损。本文介绍了一种新的手术技术，可用于处理这些缺损，并报告了 8 例采用该新技术进行翻修 TKA 的结果。
新手术将股直肌或股外侧肌及其胫骨附着点或两者的肌肉及其远端扩张部与腓肠肌和比目鱼肌皮瓣一起转移，以覆盖前膝的主要缺陷。对 9 个尸体膝关节标本进行解剖以确定转移对肌肉的神经和血液供应的影响。
2005 年至 2009 年期间，8 例患者接受了新手术。4 例膝关节行股直肌转移术，2 例行股直肌和股外侧肌转移术，2 例行股直肌和内侧腓肠肌转移术，2 例行内侧腓肠肌和内侧半比目鱼肌转移术。最小随访时间为 15 个月（平均 43 个月；范围，15-74 个月）。对患者进行了前膝疼痛、膝关节闭合质量、ROM、伸膝延迟、步行能力、辅助设备的使用以及患肢上下楼梯的能力评估。
所有患者术后 10 天内膝关节均闭合，无滑膜渗漏。末次随访时平均屈曲挛缩 3°（范围，0°-7°）。平均伸膝延迟 22°（范围，5°-65°）。包括腓肠肌或比目鱼肌转移的膝关节的伸膝延迟较小。所有皮瓣均未发生坏死。
股直肌和股外侧肌可为膝关节前侧软组织缺损提供足够的覆盖。
