前交叉韧带断裂合并半月板损伤的关节镜手术治疗

Arthroscopic Reconstruction for the Rupture of Anterior Cruciate Ligament Combine with Meniscal Injury

目的探讨关节镜下治疗膝关节前交叉韧带(anterior cruciate ligament,ACL)断裂合并半月板损伤的治疗效果。方法回顾72例ACL断裂合并半月板损伤的临床资料,其中ACL断裂并内侧半月板损伤25例,并外侧半月板损伤37例,并内、外侧半月板损伤9例,双膝均有ACL断裂并半月板损伤1例。行关节镜下单纯半月板切除9例,半月板切除(或缝合)同时ACL重建63例。术前Lysholm评分为42.5±10.5;单纯半月板切除组为45.7±9.6;同时ACL重建组为40.9±12.7。结果术后均获随访,平均3.1年,术后总Lysholm评分为82.2±12.5;单纯半月板切除组为78.6±11.8;同时ACL重建组为85.3±9.0,三者组内手术前后比较,术后均优于术前(P<0.001);而同时ACL重建组又优于单纯半月板切除组(P<0.01)。结论ACL损伤后膝关节发生半月板损伤的可能性增高,一期同时修复可以减少膝关节其它继发损伤的发生。

Objective To investigate the effects of arthroseopie reconstruction for the rupture of anterior eruciate ligament（ACL） combined with the meniseal injury. Methods The clinical data of 72 cases of ACL rupture combined with meniseal injury was retrospectively analyzed, in whom 25 of medial menisci, 37 of lateral menisci, 9 of both sides, and 1 of both knees injuries. All the operations were undergone under arthroseope, in which 9 of single menisci reseetions, and 63 of both menisci resections （or menisci suturations） and ACL re- constructions. The total Lysholm score was 42.5 ± 10.5, the score of the single menisci resection group was 45.7 ± 9.6,and the seore of the simultaneous ACL reeonstruction was 40.9± 12.7 before operation. Results All the eases were followed up for 3.1 years averagely. The postoperative Lysholm score was 82.2 ± 12.5 of the total, 78.6 ± 11.8 of the single menisci resection group, and 85.3 ± 9.0 of the simultaneous reconstruction group. There were signifieant differences between the pre- and post-operation Lysholm score in every group （ P 〈 0.001 ） , and between the two different surgical groups （ P 〈 0.001 ）. Conclusion It is important for surgeons to re-establish the stability of the knee by repairing the ACL and the menisei simultaneously to avoid more secondum injuries.