Petersen Wolf, Mustafa Hassan Al, Buitenhuis Johannes, Braun Karl, Häner Martin
Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland.
Oper Orthop Traumatol. 2025 Feb;37(1):62-69. doi: 10.1007/s00064-024-00857-7. Epub 2024 Aug 28.
Lengthening of the quadriceps tendon for dehiscence in chronic rupture.
Chronic rupture of the quadriceps tendon with delayed diagnosis or failure of primary refixation with a dehiscence between 1 and 5 cm.
Dehiscence of more than 5 cm.
Reopen the old incision and lengthen it to about 20-25 cm if necessary. Visualize the rupture. Debridement of the tendon and the insertion. Measurement of the dehiscence. Creation of a V-flap and reinforcement with a holding seam. Gradual mobilization of the V‑flap distally and reinforcement with two strong suture cords (braided suture size 5). Drilling of three obliquely ascending drill holes through the patella. Transosseous threading of the two reinforcement cords through the three drill holes. Knotting the reinforcement cords on the patella. Closure of the gap between the patella and the superficial tendon leaflet with a #2 braided suture. Closure of the gap between the V‑flap and the quadriceps tendon.
Six weeks of partial weight-bearing with 20 kg in a straight orthosis. Mobility: weeks 1-4 E/F 0-0-60, weeks 5 and 6 E/F 0-0-90.
We were able to follow-up 8 patients (mean age: 63.1 ± 4.5 years), who underwent this surgery in the manner described. All patients were able to perform an active extension postoperatively. The Lysholm score increased from 46.4 (± 5.4) points preoperatively to 81.6 (± 6.5) points postoperatively. No further rupture was detectable in the ultrasound examination at latest follow-up after an average of 27 (18-36) months.
用于慢性股四头肌肌腱断裂处的延长术。
股四头肌肌腱慢性断裂，诊断延迟或初次固定失败且裂口在1至5厘米之间。
裂口超过5厘米。
重新打开原切口，如有必要将其延长至约20 - 25厘米。显露断裂处。清理肌腱及其附着点。测量裂口大小。制作一个V形皮瓣并用固定缝线加强。将V形皮瓣逐渐向远端游离并使用两根粗缝线（5号编织缝线）加强。通过髌骨钻三个斜向上的钻孔。将两根加强缝线经骨穿过三个钻孔。在髌骨上结扎加强缝线。用2号编织缝线闭合髌骨与肌腱浅层瓣之间的间隙。闭合V形皮瓣与股四头肌肌腱之间的间隙。
六周部分负重，佩戴直腿矫形器，负重20千克。活动度：第1至4周伸直/屈曲0 - 0 - 60度，第5和6周伸直/屈曲0 - 0 - 90度。
我们对8例采用上述方法接受该手术的患者（平均年龄：63.1±4.5岁）进行了随访。所有患者术后均能主动伸直。Lysholm评分从术前的46.4（±5.4）分提高到术后的81.6（±6.5）分。在平均27（18 - 36）个月的末次随访时，超声检查未发现进一步的断裂。
