非可吸收编织线修复医源性内侧副韧带损伤的短期效果评估
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摘要
背景:医源性膝关节内侧副韧带(MCL)损伤为罕见的术中并发症,目前并无大量案例报道,其补救方法多样但尚无公认的最优补救措施。目的:探讨利用非可吸收编织线修复全膝关节置换术(TKA)术中MCL医源性损伤的短期临床疗效。方法:回顾性分析2015年1月至2016年10月新疆医科大学第一附属医院采用非可吸收编织线修补TKA术中MCL医源性损伤的5例患者的临床资料,并与同期同组医师所行TKA据膝关节评分法(KSS评分)对比MCL医源性损伤组与MCL未损伤组患者预后的差异。结果:5例MCL医源性损伤患者术后9个月的KSS膝关节疼痛、功能评分平均为(84.6±5.6)分、(81.0±2.2)分;10例MCL未损伤患者的KSS膝关节疼痛、功能评分分别为(89.8±3.7)分、(90.0±4.1)分。两组KSS0.001)。结论:TKA术中发生MCL医源性损伤患者及时使用非可吸收编织线进行修补,按需要与否使用更厚的聚乙烯垫片来达到内外侧软组织平衡,其短期治疗效果良好。
Background: Iatrogenic injury of medial collateral ligament of knee joint is a rare intraoperative complication,which was not reported a lot at present. Although there are various remedies, no optimal remedies has been found. Objective:To evaluate the short-term effect of non-absorbable sutures repairing medial collateral ligament(MCL) injuries occurring during total knee arthroplasty(TKA). Methods: From January 2015 to October 2016, clinical data from 5 patients with MCL injured during the TKA process and repaired with non-absorbable sutures were retrospectively analyzed. Another 10 patients without MCL injury during the TKA process by the same surgeons during the same period were observed as control. Knee society score(KSS) was used to assess the difference in prognosis between the patients with iatrogenic injury of medial collateral ligament and the patients without such injury. Results: There were statistically significant difference in KSS pain and function scores [(84.6±5.6) vs(89.8±3.7),(81.0±2.2) vs(90.0±4.1); P=0.048, 0.001] between the MCL injured patients and the patients without MCL injury. Conclusions: The MCL injuries can be repaired with non-absorbable sutures during TKA and whether thicker polyethylene gasket is used for medial and lateral soft tissue balance is depending on the need.The early postoperative outcomes are satisfactory.
Background: Iatrogenic injury of medial collateral ligament of knee joint is a rare intraoperative complication,which was not reported a lot at present. Although there are various remedies, no optimal remedies has been found. Objective:To evaluate the short-term effect of non-absorbable sutures repairing medial collateral ligament(MCL) injuries occurring during total knee arthroplasty(TKA). Methods: From January 2015 to October 2016, clinical data from 5 patients with MCL injured during the TKA process and repaired with non-absorbable sutures were retrospectively analyzed. Another 10 patients without MCL injury during the TKA process by the same surgeons during the same period were observed as control. Knee society score(KSS) was used to assess the difference in prognosis between the patients with iatrogenic injury of medial collateral ligament and the patients without such injury. Results: There were statistically significant difference in KSS pain and function scores [(84.6±5.6) vs(89.8±3.7),(81.0±2.2) vs(90.0±4.1); P=0.048, 0.001] between the MCL injured patients and the patients without MCL injury. Conclusions: The MCL injuries can be repaired with non-absorbable sutures during TKA and whether thicker polyethylene gasket is used for medial and lateral soft tissue balance is depending on the need.The early postoperative outcomes are satisfactory.
引文
[1]Imbert P,D'Ingrado P,Cavalier M,et al.Percutaneous Medial Ligament Reconstruction for Valgus Knee Instability.JArthroscopy Techniques,2018,7(7):e767-e772.
[2]Tio M,Basora M,Rios J,et al.Severe and morbid obesity and transfusional risk in total knee arthroplasty:An Observational Study.J Knee,2018,25(5):923-931.
[3]Brown MJC,Vella-Baldacchino M,O'Flaherty E,et al.Predicting patient reported outcome in total knee arthroplasty using body mass index and limb measurements.J Knee,2018,25(5):915-922.
[4]Winiarsky K,Barth P,Lotke P.Total knee arthroplasty in morbidly obese patients.J Bone joint Sury Am,1998,80(12):1770-1774.
[5]Lee GC,Lotke PA.Management of intraoperative medial collateral ligament injury during TKA.J Clin Orthop Relat Res,2011,469(1):64-68.
[6]Jung KA,Lee SC,Hwang SH,et al.Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty.J Knee,2009,16(6):479-483.
[7]Jain JK,Agarwal S,Sharma RK.Ligament reconstruction/advancement for management of instability due to ligament insufficiency during total knee arthroplasty:a viable alternative to constrained implant.J Orthop Sei,2014,19(4):564-570.
[8]Koo MH,Choi CH.Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty.JArthroplasty,2009,24(8):1249-1253.
[9]Leopold SS,Mcstay C,Klafeta K,et al.Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty.J Bone Joint Surg Am,2001,83A(1):86-91.
[10]Shahi A,Tan TL,Tarabichi S,et al.Primary repair of iatrogenic medial collateral ligament injury during TKA:A modified technique.J Arthroplasty,2015,30(5):854-857.
[11]Stephens S,Poloti J,Backes J,et al.Repair of medial collateral ligament injury during total knee arthroplasty.J Orthopedics,2012,35(2):e154-159.
[12]Siqueira MB,Haller K,Mulder A,et al.Outcomes of medial collateral ligament injuries during total knee arthroplasty.JKnee Surg,2016,29(1):68-73.
[13]Georgiev GP,Landzhov B,Kotov G,et al.Matrix Metalloproteinase-2 and-9 Expression in the Epiligament of the Medial Collateral and Anterior Cruciate Ligament in Human Knees:A Comparative Study.J Cereus,2018,10(11):e3550.
[14]Trofa DP,Sonnenfeld JJ,Song DJ,et al.Distal Knee Medial Collateral Ligament Repair With Suture Augmentation.J Arthroscopy Techniques,2018,7(9):e921-e926.
[15]Abramowitch SD,Yagi M,Tsuda E,et al.The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury-a biomechanical study in a goat model.J Orthop Res,2003,21(6):1124-1130.
[16]Athwal KK,Hunt NC,Davies AJ,et al.Clinical biomechanics of instability related to total knee arthroplasty.J Clin Biomech(Bristol,Avon),2014,29(2):119-128.
[17]Migliorini F,Eschweiler J,Tingart M,et al.Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty:ameta-analysis of clinical trials.J European Journal of Orthopaedic Surgery&Traumatology:Orthopedie Traumatologie,2019,19(1):15-27.
[18]Easley ME,Isnall JN,Scuderi GR,et al.Primary constrained condylar knee arthroplasty for the arthritic valgus knee.J Clin Orthop Relat Res,2000,(380):58-64.
[19]Lombardi AV,Berend KR.Posterior cruciate ligament-retaining,posteriorstabilized,andvarus/valgus posterior stabilized constrained articulations in total knee arthroplasty.JInstr Course Lect,2006,55:419-427.
[20]宋玉成,方锐,孟庆才,等.限制性衬垫在老年患者初次膝关节置换中的应用.中国组织工程研究,2014,18(17):2643-2648.
[21]Yamaji T,Levine RE,Woo SL,et al.Medial collateral ligament healing one year after a concurrent medial collateral ligament and anterior cruciateligament injury:an interdisciplinary study in rabbits.J Orthop Res,1996,14(2):223-227.
[22]袁振,郝跃峰,许檬磊,等.采用激光技术实现经胫骨隧道单束解剖重建前交叉韧带的可行性研究.中华骨与关节外科杂志,2018,11(3):208-215.
[23]Barrett IJ,Krych AJ,Pareek A,et al.Short-to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury.J Knee Surgery Sports Traumatology Arthroscopy,2018,26(10):2952-2959.
[24]Frank CB,Loitz BJ,Shrive NG.Injury location affects ligament healing.A morphologic and mechanical study of the healing rabbit medical collateral ligament.J Acta Orthop Scand,1995,66(5):455-462.
[2]Tio M,Basora M,Rios J,et al.Severe and morbid obesity and transfusional risk in total knee arthroplasty:An Observational Study.J Knee,2018,25(5):923-931.
[3]Brown MJC,Vella-Baldacchino M,O'Flaherty E,et al.Predicting patient reported outcome in total knee arthroplasty using body mass index and limb measurements.J Knee,2018,25(5):915-922.
[4]Winiarsky K,Barth P,Lotke P.Total knee arthroplasty in morbidly obese patients.J Bone joint Sury Am,1998,80(12):1770-1774.
[5]Lee GC,Lotke PA.Management of intraoperative medial collateral ligament injury during TKA.J Clin Orthop Relat Res,2011,469(1):64-68.
[6]Jung KA,Lee SC,Hwang SH,et al.Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty.J Knee,2009,16(6):479-483.
[7]Jain JK,Agarwal S,Sharma RK.Ligament reconstruction/advancement for management of instability due to ligament insufficiency during total knee arthroplasty:a viable alternative to constrained implant.J Orthop Sei,2014,19(4):564-570.
[8]Koo MH,Choi CH.Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty.JArthroplasty,2009,24(8):1249-1253.
[9]Leopold SS,Mcstay C,Klafeta K,et al.Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty.J Bone Joint Surg Am,2001,83A(1):86-91.
[10]Shahi A,Tan TL,Tarabichi S,et al.Primary repair of iatrogenic medial collateral ligament injury during TKA:A modified technique.J Arthroplasty,2015,30(5):854-857.
[11]Stephens S,Poloti J,Backes J,et al.Repair of medial collateral ligament injury during total knee arthroplasty.J Orthopedics,2012,35(2):e154-159.
[12]Siqueira MB,Haller K,Mulder A,et al.Outcomes of medial collateral ligament injuries during total knee arthroplasty.JKnee Surg,2016,29(1):68-73.
[13]Georgiev GP,Landzhov B,Kotov G,et al.Matrix Metalloproteinase-2 and-9 Expression in the Epiligament of the Medial Collateral and Anterior Cruciate Ligament in Human Knees:A Comparative Study.J Cereus,2018,10(11):e3550.
[14]Trofa DP,Sonnenfeld JJ,Song DJ,et al.Distal Knee Medial Collateral Ligament Repair With Suture Augmentation.J Arthroscopy Techniques,2018,7(9):e921-e926.
[15]Abramowitch SD,Yagi M,Tsuda E,et al.The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury-a biomechanical study in a goat model.J Orthop Res,2003,21(6):1124-1130.
[16]Athwal KK,Hunt NC,Davies AJ,et al.Clinical biomechanics of instability related to total knee arthroplasty.J Clin Biomech(Bristol,Avon),2014,29(2):119-128.
[17]Migliorini F,Eschweiler J,Tingart M,et al.Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty:ameta-analysis of clinical trials.J European Journal of Orthopaedic Surgery&Traumatology:Orthopedie Traumatologie,2019,19(1):15-27.
[18]Easley ME,Isnall JN,Scuderi GR,et al.Primary constrained condylar knee arthroplasty for the arthritic valgus knee.J Clin Orthop Relat Res,2000,(380):58-64.
[19]Lombardi AV,Berend KR.Posterior cruciate ligament-retaining,posteriorstabilized,andvarus/valgus posterior stabilized constrained articulations in total knee arthroplasty.JInstr Course Lect,2006,55:419-427.
[20]宋玉成,方锐,孟庆才,等.限制性衬垫在老年患者初次膝关节置换中的应用.中国组织工程研究,2014,18(17):2643-2648.
[21]Yamaji T,Levine RE,Woo SL,et al.Medial collateral ligament healing one year after a concurrent medial collateral ligament and anterior cruciateligament injury:an interdisciplinary study in rabbits.J Orthop Res,1996,14(2):223-227.
[22]袁振,郝跃峰,许檬磊,等.采用激光技术实现经胫骨隧道单束解剖重建前交叉韧带的可行性研究.中华骨与关节外科杂志,2018,11(3):208-215.
[23]Barrett IJ,Krych AJ,Pareek A,et al.Short-to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury.J Knee Surgery Sports Traumatology Arthroscopy,2018,26(10):2952-2959.
[24]Frank CB,Loitz BJ,Shrive NG.Injury location affects ligament healing.A morphologic and mechanical study of the healing rabbit medical collateral ligament.J Acta Orthop Scand,1995,66(5):455-462.