半月板桶柄样撕裂修补失效原因分析

Analysis of factors affecting the failure rate of bucket-handle meniscus tear repairs

目的采用病例-对照研究方法对半月板桶柄样撕裂（bucket-handle tear，BHT）的修补失效原因进行回顾性分析。方法2002年5月至2007年11月连续完成175例关节镜下BHT修补术，于术后平均23个月（11-66个月）对其中98例101个半月板进行二次关节镜手术探查。探查术中半月板愈合情况作为评价修补成功（完全愈合与部分愈合）或失效（不愈合）的指标。将患者按照不同的可能影响愈合的因素进行分组，分析组间失效率的差异。结果半月板完全愈合77个（76．2％），部分愈合11个（10．9％），不愈合13个（12．9％）。年龄〉35岁与≤35岁的BHT失效率为25．0％（4／16）、10．6％（9／85）（x2=2．494，P〉0．05）；陈旧性（〉8周）与急性（≤8周）BHT失效率为11．5％（9R8）、17．4％（4／23）（x^2=0．543，p〉0．05）；内侧、外侧半月板BHT失效率为13．3％（12／90）、9．1％（1／11）（x^2=O．157，P〉0．05）；红-红区与红-白区BHT失效率为15．0％（9／60）、9．8％（4／41）（x^2=0．597，P〉0．05）；单独应用自内向外缝合、联合应用自内向外缝合及全关节内式缝合、单独应用全关节内式缝合三组BHT失效率分别为22．0％（9／41）、7．2％（4／55）、0（0／5）（X^2=5．290，P〉0．05）；有绞锁史与无绞锁史患者的BHT失效率为26．7％（8／30）、7．0％（5，71）（x^2=7．242，P〈0．05）；二次探查时侧一侧差值≤2mm、2-5mm及≥5mm三组失效率为7．9％（7，89）、25．0％（1／4）、62．5％（3／8）（x^2=20．084，尸〈0．05）。BHT修补术总体失效率为12．9％。结论术前有膝关节绞锁史及术后膝关节稳定性差的患者BHT修补失效率明显增高。

Objective To analyze the factors affecting the failure rate of bucket-handle meniscus tear （BHT） repairs by a retrospective case-control study. Methods From May 2002 to November 2007, 175 consecutive patients underwent arthroscopic BHT repairs. 98 （101 tears） of 175 patients were available for second-look arthroscopy evaluation on an average of 23 months （range 11 to 66 months） postoperatively for meniscus healing assessment. Several possible factors that might affect the failure rate of the repaired menis- cus were statistically analyzed. Results Of the 101 repairs, 77 （76.2%） had completely healed, 11 （10.9%） had incompletely healed, and 13 （12.9%） had not healed. 95 of 98 patients had concurrent anterior cruciate ligament （ACL） injury. 4 failures （25.0%） were in the older group （〉35 years old） compared with 9 （10.6%） in the younger group （≤35 years old） （X^2=2.494, P〉0.05）. 9 failures （11.5%） occurred in the chronic group （〉8 weeks from injury to repair） compared with 4 （17.4%） in the acute group （≤8 weeks from injury to repair） （X^2=0.543, P〉0.05）. 12 medial BHT repairs （13.3%） failed, 1 （9.1%） lateral BHT repair failed （X^2= 0.157, P〉0.05）. Failure rate was 15% in patients with red-red zone BHT and was 9.8% in patients with red-white zone BHT （X^2=0.597, P〉0.05）. Suture techniques used to repair BHT did not have a significant effect on failure rate of the repair （X^2=5.290, P〉0.05）. 8 （26.7%） failures were in the locking group and 5 （7.0%） were in the unlocking group （X^2=7.242, P〈 0.05）. Knee stability at the time of second-look arthroscopy did have a significant effect on the failure rate of the repair （X^2=-20.084, P〈 0.05）. The failure rate of BHT repairs was 12.9 % during the follow-up period. Conclusion The failure rate of BHT is higher in the patients with a history of locking and unstable knee.