“环抱”缝合法修复内侧半月板桶柄状撕裂中期疗效观察

发布时间：2018-10-16 10:02

【摘要】：目的探讨"环抱"缝合法修复内侧半月板桶柄状撕裂(bucket-handle tear,BHT)的中期疗效。方法总结2011年3月—2013年6月采用关节镜下"环抱"缝合法修复内侧半月板BHT的78例(78膝)患者临床资料。男57例,女21例;年龄16~39岁,平均28.3岁。致伤原因:运动损伤61例,交通事故伤12例,其他伤5例。新鲜损伤35例,陈旧性损伤43例。合并前交叉韧带损伤65例。术前国际膝关节文献委员会(IKDC)评分、Lysholm评分、Tegner评分分别为(48.2±6.3)、(43.6±4.7)、(2.5±0.6)分。MRI检查示半月板Ⅲ度撕裂。术后采用Barrett等的评价标准、MRI检查、二次关节镜检查评估半月板愈合情况,并采用IKDC评分、Lysholm评分和Tegner评分评价膝关节功能。结果术后切口均Ⅰ期愈合,无关节感染、异物排斥等并发症发生。患者均获随访,随访时间26~63个月,平均42.8个月。2例术后1年内BHT复发。末次随访时,根据Barrett等的标准,72例半月板达临床愈合,临床愈合率为92.3%。IKDC评分、Lysholm评分、Tegner评分分别为(81.5±5.1)、(86.9±3.9)、(6.2±0.5)分,与术前比较差异均有统计学意义(t= 14.598,P=0.000;t= 18.478,P=0.000;t= 3.362,P=0.002)。MRI复查示,末次随访时56例半月板完全愈合,15例部分愈合,7例全层面不愈合,总愈合率为91.0%(71/78)、完全愈合率为71.8%(56/78)。21例于术后18~49个月行二次关节镜探查,其中17例半月板达完全愈合,4例为部分愈合,总愈合率为100%(21/21)、完全愈合率为81.0%(17/21);均无新撕裂出现。结论采用关节镜下"环抱"缝合法修复内侧半月板BHT,具有缝合牢固、对半月板血供影响小的特点,可取得满意的中期疗效。
[Abstract]:Objective to investigate the mid-term curative effect of medial meniscus barrel shank tear (bucket-handle tear,BHT) repaired by encircling suture. Methods from March 2011 to June 2013, 78 patients (78 knees) with medial meniscus BHT were treated with arthroscopic "encircling" suture. There were 57 males and 21 females, aged 1639 years with an average age of 28.3 years. The causes of injury were 61 cases of sports injury, 12 cases of traffic accident and 5 cases of other injuries. 35 cases of fresh injury and 43 cases of old injury. 65 cases were complicated with anterior cruciate ligament injury. The scores of (IKDC), Lysholm and Tegner were (48.2 卤6.3), () 卤4.7), (2.5 卤0.6). MRI examination showed meniscus third degree tear. The meniscus healing was evaluated by Barrett, MRI and arthroscopy. The knee joint function was evaluated by IKDC, Lysholm and Tegner. Results all the incisions healed in the first stage without joint infection and foreign body rejection. All patients were followed up for 26 ~ 63 months with an average of 42.8 months. BHT recurred in 2 patients within 1 year after operation. At the last follow-up, according to the criteria of Barrett et al, 72 cases of meniscus healed clinically, the clinical healing rate was 92.3%.IKDC score, Lysholm score and Tegner score were (81.5 卤5.1), (86.9 卤3.9), (6.2 卤0.5), respectively, which were significantly different from those before operation (t = 14.598P0.000t = 18.478P0.000t = 3.362p 0.002). MRI). At the last follow-up, 56 cases were completely healed, 15 cases were partially healed, 7 cases were completely nonunion, the total healing rate was 91.0% (71 / 78), and the complete healing rate was 71.8% (56 / 78). The meniscus healed completely in 17 cases and partial healing in 4 cases. The total healing rate was 100% (21 / 21) and the complete healing rate was 81.0% (17 / 21). Conclusion the repair of medial meniscus BHT, by "encircling" suture under arthroscopy has the characteristics of firm suture, little influence on meniscus blood supply, and satisfactory intermediate curative effect.
【作者单位】：深圳大学第一附属医院(深圳市第二人民医院)运动医学科;
【基金】：广东省科技计划项目(2014A020212656、2014A030401017) 深圳市卫生计生系统科研项目(201506025) 深圳市科技研发计划项目(JCYJ20140414170821213、JCYJ20140414170821157)~~
【分类号】：R687.4

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