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单一同种异体内侧副韧带和后斜韧带重建:一种改善外翻和旋转稳定性的技术。

Single allograft medial collateral ligament and posterior oblique ligament reconstruction: a technique to improve valgus and rotational stability.

作者信息

Dong Jiangtao, Ji Gang, Zhang Yingze, Gao Shijun, Wang Fei, Chen Baicheng

机构信息

Department of Joint Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.

出版信息

Eur J Orthop Surg Traumatol. 2014 Aug;24(6):1025-9. doi: 10.1007/s00590-013-1265-3. Epub 2013 Jun 27.

DOI:10.1007/s00590-013-1265-3
PMID:23807396
Abstract

We present a novel and simple method for single hamstring allograft MCL and PMC reconstruction, which can improve both joint valgus and external rotational stability and maximize utilization of allograft. All patients received arthroscopic evaluation through inferomedial and inferolateral knee incisions to ascertain whether there were intra-articular injuries. An 8-cm-length longitudinal incision was made from 1 cm above adductor tubercle to 5-cm proximal medial tibia joint line. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm below the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm below the medial tibia joint line. A 5- or 6-mm reamer was used to drill the tibia tunnel along with guide pin, and a 6 or 7 mm drill was used to drill the femur tunnel to a depth of 25 or 30 mm until the proximal adductor tubercle. The allograft was harvested from tibia and placed into the tunnel and fixed with absorbable interference screw. All patients performed active rehabilitation exercises after the operation periodically.

摘要

我们提出了一种新颖且简单的单根腘绳肌同种异体移植物重建内侧副韧带(MCL)和后内侧角(PMC)的方法,该方法可改善关节外翻和外旋稳定性,并最大限度地利用同种异体移植物。所有患者均通过膝关节内下和外下切口接受关节镜评估,以确定是否存在关节内损伤。从内收肌结节上方1 cm至胫骨近端关节线内侧5 cm处做一个8 cm长的纵向切口。胫骨前插入点定义为距胫骨内侧边缘外侧15 mm且在胫骨内侧关节线下方45 mm处。胫骨后插入点定义为距胫骨内侧边缘外侧15 mm且在胫骨内侧关节线下方20 mm处。使用5或6 mm的扩孔钻沿导针钻胫骨隧道,使用6或7 mm的钻头钻股骨隧道至25或30 mm深度,直至近端内收肌结节。从胫骨获取同种异体移植物,放入隧道并用可吸收挤压螺钉固定。所有患者术后定期进行主动康复锻炼。

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Eur J Orthop Surg Traumatol. 2014 Aug;24(6):1025-9. doi: 10.1007/s00590-013-1265-3. Epub 2013 Jun 27.
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本文引用的文献

1
Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability.慢性内侧副韧带不稳定患者膝关节内侧副韧带及后内侧角的解剖重建
Am J Sports Med. 2009 Jun;37(6):1116-22. doi: 10.1177/0363546509332498. Epub 2009 Mar 31.
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Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation.膝关节脱位后多韧带损伤两阶段治疗的手术结果
Arthroscopy. 2007 Oct;23(10):1066-72. doi: 10.1016/j.arthro.2007.05.008.
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Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament.
内侧副韧带孤立伤和合并伤的保守治疗及术后康复
Sports Med Arthrosc Rev. 2006 Jun;14(2):105-10. doi: 10.1097/01.jsa.0000212308.32076.f2.
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Evaluation and treatment of chronic medial collateral ligament injuries of the knee.膝关节慢性内侧副韧带损伤的评估与治疗
Sports Med Arthrosc Rev. 2006 Jun;14(2):84-90. doi: 10.1097/01.jsa.0000212311.77817.c8.
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MCL injuries of the knee: current concepts review.膝关节内侧副韧带损伤:当前概念综述
Iowa Orthop J. 2006;26:77-90.
6
Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases.使用自体腘绳肌腱重建内侧副韧带:技术及首例病例结果
Am J Sports Med. 2005 Sep;33(9):1380-5. doi: 10.1177/0363546504273487. Epub 2005 Jul 7.
7
Structural properties of the medial collateral ligament complex of the human knee.人类膝关节内侧副韧带复合体的结构特性
J Biomech. 2005 May;38(5):1067-74. doi: 10.1016/j.jbiomech.2004.05.034.
8
The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee.后内侧角再探讨。人膝关节内侧被动约束结构的解剖学描述。
J Bone Joint Surg Br. 2004 Jul;86(5):674-81. doi: 10.1302/0301-620x.86b5.14853.
9
Medial collateral ligament reconstruction with allograft using a double-bundle technique.
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10
Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results.内侧副韧带与前交叉韧带联合损伤时内侧副韧带的一期重建。短期结果。
Knee Surg Sports Traumatol Arthrosc. 1998;6(2):103-6. doi: 10.1007/s001670050081.