关节镜下联合修补技术治疗内侧半月板桶柄样撕裂

Arthroscopic Hybrid Suture Technique for Repairing Bucket-Handle Tear of Medial Meniscus

目的:介绍关节镜下自内向外缝合联合全内缝合技术修补半月板的手术方法和疗效。方法:采用关节镜下联合修补技术修补20例(20个)内侧半月板桶柄样撕裂,均累及内侧半月板后角至前体部区域。手术适应证:红-红区及红-白区损伤、具备可复位性、半月板无复合撕裂及明显变性、前十字韧带(ACL)损伤同时重建。撕裂的后角与体部交界处(后体部)至中、前1/3区域采用标准的自内向外缝合;撕裂的后部区域采用全关节内缝合:经两个后内侧或后外侧入路在关节内完成垂直褥式缝合。单纯的红-白区撕裂修补后局部植入血凝块促进愈合,合并ACL损伤者同时行韧带重建手术。结果:20例(20个)半月板进行了平均19.2个月(9～31个月)的随访,无症状者18例(90.0%),关节间隙压痛者2例(10.0%),20个半月板经MRI复查,完全愈合15个(75.0%),部分愈合5个(25.0%)。结论:对于发生在红-红区或红-白区的内侧半月板大型撕裂,联合修补技术是安全、可靠的修补方法。

Objective：To introduce the arthroscopic in-out repairing technique（hybrid suture tech-nique） for bucket-handle tear of medial meniscus and to present the short-term clinical outcome.Methods：20 patients with 20 repairable medial meniscus tears were enrolled.Surgical indication consists of meniscal tears involving red-red and red-white zone without obvious additional complex tears and tissue degeneration.With arthroscopic technique,the anterior and mid 1/3 portion of the lesion were repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement. For the most posterior portion, all-inside suture technique with two posterior portals were performed. For isolated red-white zone tears, fibrin clot was implanted into the repaired region for enhancing the healing pro-ACL injuries were reconstructed simultaneously. Results ：20 patients with 20 meniscal repairs were available for an average of 19.2 months follow-up （range：9-31 months）. Eighteen of 20 （90.0%） cases were asymptomatic at the latest clinical evaluation. Twenty cases received repeated MR evaluation during follow-up, showing that 15 menisci （75.0%）were completely healed, 5 （25.0%）partially healed. Conclusion： For meniseal tears involving red-red and red-white zones, arthroscopic hybrid suture technique provides stable strength along the whole length of injured region and consequently achieves satisfactory clinical outcomes.