内侧副韧带拉花松解在膝关节内侧半月板后角撕裂关节镜手术中的应用

发布时间：2018-06-07 20:20

  本文选题：内侧半月板损伤 + 内侧间室　； 参考：《中南大学学报(医学版)》2017年09期

【摘要】：目的:探讨在膝关节镜手术中,运用内侧副韧带(medial collateral ligament,MCL)拉花松解技术处理合并膝关节内侧间室紧张的内侧半月板后角(posterior horn of medial meniscus,PHMM)撕裂时的安全性和有效性。方法:2013年1月至2014年12月对32例合并膝关节内侧间室紧张的PHMM撕裂患者,均使用MCL拉花松解技术。用18号静脉穿刺针于MCL胫骨止点附近进行松解,同时取膝关节外翻位处理PHMM撕裂。术后第1天、4周、12周分别行外翻应力试验及双膝外翻应力位X线片评估MCL愈合情况。术后1,3,6个月随访,之后每半年随访1次,每次采用疼痛视觉评分(Visual Analogue Scales,VAS),Lysholm,Tegner和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分评价患侧膝关节功能。结果:32例患者均得到随访,随访时间24~36(平均28)个月。无1例MCL撕裂、股骨骨折、关节软骨损伤及神经血管损伤等并发症。双膝外翻应力位X线片内侧关节间隙测量:术后第1天健侧为(4.3±1.3)mm,患侧为(6.6±1.6)mm,二者比较差异有统计学意义(P0.05);术后4周健侧为(4.2±1.5)mm,患侧为(5.5±1.2)mm,二者比较差异有统计学意义(P0.05);术后12周健侧为(4.3±1.4)mm,患侧为(4.8±1.5)mm,二者比较差异无统计学意义(P0.05)。VAS术前4.5±1.5,最终随访为1.7±1.0,二者比较差异有统计学意义(t=16.561,P0.05);Lysholm评分术前为52.3±5.8,最终随访为93.2±6.3,二者比较差异有统计学意义(t=-41.353,P0.05);Tegner评分术前为4.1±1.1,最终随访为5.5±0.6,二者比较差异有统计学意义(t= 18.792,P0.05);IKDC主观评分术前为54.5±6.2,最终随访为93.8±4.5,二者比较差异有统计学意义(t= 38.253,P0.05)。结论:MCL拉花松解是一种安全、有效的处理合并膝关节内侧间室紧张的PHMM撕裂的手术方法。
[Abstract]:Objective: to investigate the safety and efficacy of medial collateral ligamentum ligamentus medial collateral ligament (medial collateral ligamentus) decompression technique in the treatment of posterior meniscus posterior meniscusPHMMMMM with medial interventricular tension in knee arthroscopy. Methods: from January 2013 to December 2014, 32 cases of PHMM tears complicated with medial ventricular tension of knee joint were treated with MCL technique. The venous puncture needle No. 18 was used to release the tibia near the tibia of MCL, and the knee joint valgus was taken to deal with PHMM tear. The healing of MCL was evaluated by valgus stress test and X ray film of double knee valgus stress position at 4 weeks and 12 weeks after operation. Visual Analogue scales and Lysholm Tegner and International knee documentation Committee (Ike) were used to evaluate the knee function of the affected side. Results all 32 cases were followed up for 24 ~ 36 (mean 28) months. There were no complications such as MCL laceration, femoral fracture, articular cartilage injury and neurovascular injury. Measurement of the medial joint space in the bilateral knee valgus stress position: on the 1st day after operation, the normal side was 4.3 卤1.3 mm, the affected side was 6.6 卤1.6 mm, the difference was statistically significant (P 0.05), the healthy side was 4.2 卤1.5 mm and the affected side was 5.5 卤1.2 mm at 4 weeks after operation, the difference was statistically significant (P 0.05). 12 weeks after operation, the healthy side was 4.3 卤1.4 mm and the affected side 4.8 卤1.5 mm. There was no significant difference between the two groups before operation (4.5 卤1.5) and final follow-up (1.7 卤1.0). The difference between the two groups was statistically significant (P < 0.01). The Lysholm score was 52.3 卤5.8 before operation and 93.2 卤6.3 at final follow-up. Tegner score was 4.1 卤1.1 before operation and 5.5 卤0.6 at final follow-up. There was significant difference between the two groups. The subjective score of IKDC was 54.5 卤6.2 before operation and 93.8 卤4.5 at final follow-up. There was significant difference between the two groups. Conclusion it is safe and effective to treat PHMM tears associated with medial ventricular tension of knee joint.
【作者单位】： 中南大学湘雅二医院骨科;
【基金】：湖南省财政厅科研项目(2015137)~~
【分类号】：R687.4
，

本文编号：1992677