膝关节半月板损伤的手术修复疗效观察

Investigation of surgically repaired menisci in 168 cases

目的探讨切开直视下及关节镜下缝合修复半月板损伤的疗效及术后并发症发生情况。方法1988年1月～2004年6月采用切开直接缝合法和关节镜下缝合修补方法修复半月板损伤168例170个。关节镜下方法包括穿刺打磨修复法、可吸收半月板箭复位固定法、Outside-In缝合法、Inside-Out缝合法、Elite肩袖缝合器缝合法、T-Fix固定技术和FasT-Fix固定技术。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果进行评价,并对术后的并发症进行观察。对有明显症状及体征的患者进行关节镜探查。结果所有患者获得6个月～9．5年(平均49．3±28．8个月)随访发现,Tegner评分：术前3．3±2．3,术后6．8±2．1(p＜0．05)。Lysholm评分：术前30．1±18．2,术后87．5±22．5(P＜0．01)。按Molster对Lysholm评分的分级方法,优98个,良57个,可10个,差5个,优良率为91．2%。对术后症状和体征明显的19例患者进行关节镜再探查,发现5例术愈合,6例部分愈合。术后并发症包括Outside-In缝线打结处疼痛3例,外侧半月板前角Outside-In缝合后未愈合导致后关节囊牵拉痛1例,半月板箭固定处的后关节囊刺痛5例。无严重血管、神经损伤,术后并发症的总发生率为5．3%。结论选择适当方法对损伤半月板进行修复可明显改善膝关节的症状和功能评分,并且具有较高的手术成功率和较少的术中、术后风险。

Objective To investigate the clinical effects and postoperative complications of arthrotomy and arthroscopy in repair of 170 menisci in 168 cases. Methods One hundred and sixty-eight patients with meniscus injury were repaired by arthrotomy or arthroscopy. They were 121 males and 47 females. There were 77 left knees and 91 right knees; 117 medial menisci and 53 lateral ones. Their average age was 25.5 ± 8.4 years old. Arthroscopic repair methods included puncture and grinding, bio-absorbable meniscus arrow fixation, Outside-In suturing, Inside-Out suturing, Elite scuff instrument repairing, T-Fix fixation and FasT-Fix fixation techniques. The clinical results were assessed on the basis of symptoms, physical signs, Tegner scores and Lysholm scores of the cases. Postoperative complications were also investigated. Re- rthroscopic exploration was done for patients with obvious symptoms and physical signs. Results The average follow-up time was 49.3 ± 28.8 months. Their mean preoperative Tegner score was 3.3 ± 2.3, and their postoperative one 6. g ± 2. 1 （ P 〈 O. 05） . Their preoperative Lysholm score was 30. 1 ± 18.2, and their postoperative one 87.5 ± 22.5 （ P 〈 0. 01 ） . There were significant differences in Tegner and Lysholm scores before operation and after operation. Ninety-eight repaired menisci were rated as excellent（57.7% ）, 57 as good （33.5%）, 10 as fair （5.9%）, and five as poor （2.9%）. The total excellent and good result was 91.2%. Of the 19 patients with obvious symptoms and physical signs, re-arthroscopic exploration found no healing in five and partial healing in six. Postoperative complications included pain at the Outside-In suture nodes in three cases, referred pain at posterior articular capsule resulted from failed Outside-In meniscus anterior horn suturing in one case, and twinge at the meniscus arrow site in the posterior capsule in five cases. No serious lesion occurred at blood vessels or nerves. The postoperative complication incidence was 5.3%. Conclusion The eight methods of arthrotomy and arthroscopy to repair injured menisci investigated in our study can have a high successful rate and low perioperative and postoperative risk.