关节镜下一期治疗前交叉韧带损伤合并半月板桶柄样撕裂的疗效观察

发布时间：2018-04-02 23:08

  本文选题：关节镜　切入点：前交叉韧带　出处：《中国修复重建外科杂志》2017年05期

【摘要】：目的探讨关节镜下前交叉韧带(anterior cruciate ligament,ACL)重建联合半月板缝合修补术治疗ACL损伤合并半月板桶柄样撕裂(bucket-handle tear,BHT)的临床疗效。方法将2013年1月—2014年4月收治并符合选择标准的22例(22膝)ACL损伤合并半月板BHT患者纳入研究。其中,男14例,女8例;年龄15~44岁,平均30.68岁。左膝10例,右膝12例。内侧半月板损伤14例,外侧8例。初次受伤至入院时间为9h~4年,中位时间40d。于关节镜下首先行半月板缝合修补术,然后行ACL单束重建。结果术后患者切口均Ⅰ期愈合,均未出现感染、血管神经损伤等严重并发症。22例患者均获随访,随访时间12~42个月,平均26.7个月。1例术后6周关节功能活动仍受限,经麻醉下手法松解后功能恢复良好;1例存在关节间隙压痛,经保守治疗后疼痛缓解。临床有效率为90.9%(20/22)。末次随访时,患者前抽屉试验、Lachman试验、Mc Murray试验均为阴性。术后12个月疼痛视觉模拟评分(VAS)、Tegner运动水平评分、Lysholm评分均较术前显著改善,比较差异有统计学意义(P0.05)。术后6~12个月行MRI复查,参考Crues等的MRI评估标准,7例完全愈合,11例部分愈合,4例不愈合。随访期间均无ACL再断裂发生。结论关节镜下半月板缝合修补联合ACL单束重建治疗ACL损伤合并BHT,能有效缓解临床症状、降低半月板再次撕裂概率,延缓关节软骨退行性变,维持膝关节稳定性。
[Abstract]:Objective to investigate the clinical effect of arthroscopic anterior cruciate ligamentum reconstruction combined with meniscus suture repair in the treatment of ACL injury with bucket-handle laceration.Methods from January 2013 to April 2014, 22 patients with meniscus BHT were included in the study.Among them, there were 14 males and 8 females, aged 1544 years with an average of 30.68 years old.There were 10 cases of left knee and 12 cases of right knee.Medial meniscus injury was found in 14 cases and lateral meniscus injury in 8 cases.The time from first injury to admission was 9 h ~ 4 years and the median time was 40 d.Meniscus suture repair was performed under arthroscopy, and then ACL single bundle reconstruction was performed.Results all the incisions healed in the first stage without infection. All the 22 patients were followed up with severe complications such as vascular and nerve injury. The follow-up time was 12 ~ 42 months (mean 26.7 months), and the function of joint function was still limited 6 weeks after operation in 1 cases (average 26.7 months).After anaesthesia, 1 case had tenderness of joint space and the pain was relieved after conservative treatment.The clinical effective rate was 90.9 / 20 / 22.At the last follow-up, the Lachman test and MC Murray test were all negative.The visual analogue score of pain and the Lysholm score of Tegner motor level were significantly improved at 12 months after operation, and the difference was statistically significant (P 0.05).MRI was performed 6 ~ 12 months after operation. According to the MRI evaluation criteria of Crues et al, 7 cases were completely healed and 11 cases were partially healed and 4 cases were nonunion.No ACL rerupture occurred during follow-up.Conclusion meniscus suture repair combined with ACL single bundle reconstruction under arthroscopy can effectively relieve the clinical symptoms, reduce the probability of meniscus retear, delay the degeneration of articular cartilage and maintain the stability of knee joint.
【作者单位】： 山东中医药大学;山东中医药大学附属医院手术室;山东中医药大学附属医院运动损伤骨科;
【分类号】：R687.4
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本文编号：1702514