关节镜下异体半月板移植微创手术初步报告

A preliminary report on arthroscopic transplantation of meniscal allograft

目的总结关节镜下同种异体半月板移植微创手术中移植物制备、手术操作和术后康复过程等经验体会，为进一步开展此项技术提供参考。方法2006年11至12月对3例半月板严重损伤、大部缺损的患者，采用关节镜微创技术实施同种异体半月板移植手术，拟定术后康复计划，分别随访24、32和36周，对其结果做初步报告，并讨论异体半月板移植手术适应证和操作技术等问题。结果患者无手术副损伤，术后伤口无渗液，6周左右关节肿胀基本消失。实验室检查未发现免疫排斥反应。患者疼痛评分（VAS）术后平均降低4．7分。膝关节Lysholm评分平均由术前59．0分增至术后81．7分。膝关节活动度接近正常。结论由于半月板缺损治疗中存在的困难及半月板属免疫屏蔽器官的特点，同种异体半月板移植术可能成为治疗半月板缺损的重要方法。异体半月板移植的手术适应证为：中青年患者，半月板已切除或无法保留，无软骨下骨明显病变，无严重股骨髁或胫骨平台畸形，无感染及其他外科手术禁忌证。

Objective To report our experience of conducting 3 cases of arthroscopic transplantation of meniscal allografl. Methods Arthroscopic transplantation of meniscal allograft was performed on 3 patients suffering from severe meniscus tear or defect in November-December, 2006. Their initial clinical results and functional recovery were investigated after short-time rehabilitation. The surgical procedures and related problems were discussed in light of literature review. Results No side-injury occurred in the 3 cases. The incisions healed well without exudation. The knee joint swelling disappeared in about 6 weeks. Rejection was not observed in all the laboratory tests. The average postoperative VAS score deceased by 4. 7 points. The mean Lysholm scores increased from preoperative 59.0 to postoperative 81.7. The range of motion of the knee joint was restored to nearly normal after rehabilitation. Conclusions Due to the difficulty in treating severe meniscal tear and the immune evasion of meniscus, meniscal allograft transplantation may be a valuable option. Further study, however, is needed to clarify clinical problems, such as preservation of allograft, surgical techniques and rehabilitative programs.