关节镜下肌腱缝合修复破裂半月板的方法探讨及疗效观察

Clinical effects and methods of arthroscopic repair of meniscal tear by tendon suture

目的探讨关节镜下用肌腱(自体或异体)缝合修复破裂半月板的操作方法及治疗效果。方法于2004年10月～2005年10月,用特制的半月板缝合导针对半月板破裂损伤的35例患者行关节镜下肌腱缝合修复术治疗。其中内侧半月板30例,外侧半月板5例;半月板红-红区破裂14例,红-白区破裂21例;纵行破裂23例,纵行合并横行、水平破裂12例;单纯半月板损伤5例,合并前交叉韧带断裂25例,合并后交叉韧带断裂5例。手术同时进行前、后交叉韧带重建。结果35例患者术后获5～24个月(平均14个月)随访,无手术并发症,术前症状及体征完全消失,膝关节功能恢复正常,23例患者恢复损伤前运动水平,Lysholm膝关节功能评分,术前(59.0±9.8)分,术后(94.0±5.4)分,差异有统计学意义(P<0.01)。结论用肌腱缝合修复破裂半月板是保留半月板功能的一种安全可靠、操作简便的新技术、新方法,肌腱可促进破裂半月板再血管化及组织化是其独特的优点。此方法值得进一步深入研究并推广应用。

Objective To discuss the manipulation and outcome of arthroscopic repair of meniscus tear by autologous or allogenous tendon. Methods From October 2004 to 2005, repaired 35 injured menisci by autologous or allogenous tendon in arthroscopy assisted by special meniscal suturing guide needle （medial menisci： 30 cases, lateral menisci： 5 cases） . Lesion position： red-red zone： 14 cases; red-white zone： 21 cases; longitudinal tears： 23 cases; longitudinal with transverse and horizontal tears： 12 cases; simple meniscal tears： 5 cases, accompanied with anterior cruciate ligament（ACL） injuries： 25 cases, with posterior cruciate ligament （PCL）： 5 cases . Reconstructed ACL or PCL in the same time. Results 35 patients follow-up 5 to 24 months （mean 14 months）. No complications were found, preoperative symptoms and signs were completely disappeared. The knee joint functions recover to normal level. 23 patients, recovered to normal level, getting satisfactory outcome . Lysholm scale of the knee function： preoperatlon： 59.0±9.8, postoperation： 94.0±5.4 （ P 〈 0. 01 ） . Conclusions Suturing ruptured menisci by autologous or ailogenous tendon is a new safe and trustable technique and it can be easily manipulated. So this method seems worthy and more advancing studies needed.