Jaureguito J W, Dubois C M, Smith S R, Gottlieb L J, Finn H A
Department of Surgery, The University of Chicago, Illinois 60640, USA.
J Bone Joint Surg Am. 1997 Jun;79(6):866-73. doi: 10.2106/00004623-199706000-00010.
We describe a modified technique for the salvage of a total knee arthroplasty after disruption of the extensor mechanism. Between January and December 1992, seven patients had reconstruction of the extensor mechanism with use of a medial or an extended medial gastrocnemius flap. Six of the seven patients were followed for a mean of thirty-three months (range, twenty-six to forty-one months) and were evaluated both preoperatively and postoperatively with regard to the knee and functional scores of The Knee Society as well as the range of motion, extensor lag, walking status, and patellar height. The seventh patient was lost to follow-up six months postoperatively and was excluded from the analysis of the results. Preoperatively, the knee and functional scores were 16 +/- 12.3 points and 12 +/- 12.1 points (mean and standard deviation), respectively; the mean range of motion was 70 +/- 44.0 degrees; and the mean extensor lag was 53 +/- 33.4 degrees. Postoperatively, the mean knee and functional scores improved to 82 +/- 12.4 points and 51 +/- 23.0 points, respectively; the mean range of motion improved to 100 +/- 21.8 degrees; and the mean extensor lag decreased to 24 +/- 18.8 degrees. After the procedure, all patients who previously had been dependent on a walker were able to walk about the community with or without a cane, and those who had been dependent on a wheelchair were able to walk with the assistance of a walker. Patellar height was measured according to the method of Insall and Salvati for the four patients who had a patella. Preoperatively, the patellar heights were grossly abnormal; postoperatively, they more closely approached accepted normal values for three of the four patients. Reconstruction of a complicated rupture of the extensor mechanism with use of a medial gastrocnemius transposition flap after total knee arthroplasty is a reliable option for treatment.
我们描述了一种用于挽救伸肌机制断裂后的全膝关节置换术的改良技术。在1992年1月至12月期间，7例患者采用内侧或延伸内侧腓肠肌瓣重建伸肌机制。7例患者中的6例平均随访33个月（范围为26至41个月），术前和术后均根据膝关节协会的膝关节和功能评分以及活动范围、伸肌滞后、行走状态和髌骨高度进行评估。第7例患者术后6个月失访，被排除在结果分析之外。术前，膝关节和功能评分分别为16±12.3分和12±12.1分（平均值和标准差）；平均活动范围为70±44.0度；平均伸肌滞后为53±33.4度。术后，膝关节和功能评分平均值分别提高到82±12.4分和51±23.0分；平均活动范围提高到100±21.8度；平均伸肌滞后降至24±18.8度。手术后，所有先前依赖助行器的患者都能够在社区中行走，可使用或不使用拐杖，而那些依赖轮椅的患者能够在助行器的帮助下行走。对4例有髌骨的患者根据Insall和Salvati的方法测量髌骨高度。术前，髌骨高度严重异常；术后，4例患者中有3例更接近公认的正常值。全膝关节置换术后使用内侧腓肠肌转位瓣重建伸肌机制的复杂断裂是一种可靠的治疗选择。
