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目的探讨采用缝合桥技术修复尿毒症并发股四头肌腱断裂的疗效。方法 2010年3月-2012年9月,采用缝合桥技术修复10例(14侧)尿毒症并发股四头肌腱断裂。男8例,女2例;年龄30~62岁,平均54.2岁。尿毒症病程3~11年,平均5.5年。股四头肌腱断裂5 d~2个月,中位病程12 d。其中6例有外伤史,1例合并糖尿病。左侧2例,右侧4例;双侧4例。术前膝关节主动活动度为屈膝(115.0±8.3)°,伸膝(72.5±21.2)°。Lysholm评分为(19.5±16.3)分。X线片检查示髌骨下移,MRI检查示股四头肌腱连续性中断。结果手术时间30~50 min,平均40.3 min。术后切口均Ⅰ期愈合,无并发症发生。患者均获随访,随访时间12~25个月,平均16.3个月。随访期间无股四头肌腱再断裂及内固定物松动发生。末次随访时,膝关节主动活动度为屈膝(121.0±7.9)°,与术前比较差异无统计学意义(t=—2.075,P=0.058);伸膝(8.2±6.1)°,与术前比较差异有统计学意义(t=11.702,P=0.000)。Lysholm评分为(84.6±12.4)分,与术前比较差异有统计学意义(t=—16.226,P=0.000)。按膝关节学会评分系统(KSS)评定疗效:优4侧,良9侧,可1侧,优良率92.9%。以45岁为界分为青年组和中老年组,以2周为界分为早期手术组和晚期手术组;末次随访时,青年组及早期手术组膝关节主动屈、伸活动度及Lysholm、KSS评分优于中老年组及晚期手术组(P<0.05)。结论采用缝合桥技术修复尿毒症并发股四头肌腱断裂创伤较小,允许术后早期功能锻炼,有利于膝关节功能康复。手术时机及年龄对预后有影响,肌腱断裂后宜尽早手术。
Objective To investigate the curative effect of using suture bridge technique to repair the rupture of quadriceps tendon in uremia. Methods From March 2010 to September 2012, 10 cases (14 sides) of uremia complicated with quadriceps tendon rupture were repaired with suture bridge technique. 8 males and 2 females; aged 30 to 62 years, mean 54.2 years old. Uremia duration of 3 to 11 years, an average of 5.5 years. Quadriceps tendon rupture 5 d ~ 2 months, the median duration of 12 d. Six cases had history of trauma and one case had diabetes. 2 cases on the left side, 4 cases on the right side and 4 cases on both sides. Preoperative knees active knee flexion (115.0 ± 8.3) °, extensor knee (72.5 ± 21.2) °. Lysholm score was (19.5 ± 16.3) points. X-ray examination showed downward patella, MRI showed quadriceps tendon continuity interrupted. Results The operation time was 30-50 min with an average of 40.3 min. Postoperative incision healed, no complications. Patients were followed up for 12 to 25 months with an average of 16.3 months. No further quadriceps tendon rupture and loosening of internal fixation during follow-up. At the final follow-up, knee activity was knee flexion (121.0 ± 7.9) °, with no significant difference from preoperative (t = -2.075, P = 0.058); extensor knee (8.2 ± 6.1) °, The difference was statistically significant (t = 11.702, P = 0.000). The Lysholm score was (84.6 ± 12.4) points, which was significantly different from the preoperative value (t = -16.226, P = 0.000). According to KSS, the curative effect was evaluated: excellent 4, good 9, and good 1, the rate of excellent and good was 92.9%. At the age of 45 years old, they were divided into young group and middle-aged group, divided into two groups: early operation group and late operation group. At the last follow-up, active knee flexion and extension and Lysholm, KSS score was superior to the middle-aged group and advanced surgery group (P <0.05). Conclusion Suture bridge repair of uremia complicated by quadriceps tendon rupture less injury, allowing early postoperative functional exercise, is conducive to functional rehabilitation of the knee. The timing and age of surgery have an impact on prognosis, and surgery should be performed as soon as possible after the rupture of the tendon.