外侧半月板桶柄样撕裂联合缝合技术的应用

Hybrid suture technique for repairing bucket-handle tear of the lateral meniscus

目的 探讨关节镜下自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂的临床效果.方法 2004年11月至2009年11月,应用关节镜下联合缝合技术修复外侧半月板桶柄样撕裂17例,男10例,女7例；年龄17～42岁,平均27.8岁.使用自内向外缝合技术对外侧半月板胭肌腱前方区域的撕裂进行缝合,使用全内缝合技术对半月板后角区域的撕裂进行缝合.随访时进行体格检查、MR检查和二次关节镜探查,评估半月板愈合情况.结果 13例患者获得随访,随访时间1～5年,平均23.7个月.随访期间症状消失者12例（92.3％,12/13）,绞锁复发1例（7.7％,1/13）.MRI证实半月板完全愈合11例（84.6％,11/13）,部分愈合1例（7.7％,1/13）,不愈合1例（7.7％,1/13）.12例患者行二次关节镜探查,其中完全愈合10例（83.3％,10/12）,部分愈合1例（8.3％,1/12）,未愈合1例（8.3％,1/12）.结论 应用自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂,经术后MRI和二次关节镜探查证实半月板愈合率超过90％.

Objective To explore the clinical results of combined arthroscopic inside-out and allinside repairing techniques（hybrid suture technique）for repairing bucket-handle tear of the lateral meniscus.Methods From November 2004 to November 2009,17 consecutive patients with bucket-handle tear of the lateral meniscus underwent arthroscopic repair by hybrid suture technique,including 10 males and 7 females,with a mean age of 27.8 years（range,17-42）.The anterior popliteal tendon part of lateral meniscus was repaired using standard inside-out technique while tears of the posterior horn of lateral meniscus were repaired using all-inside suture technique.The physical examination,MRI and second-look arthroscopy were performed to evaluate the healing status of the lateral meniscus at the final follow-up.Results Of the 17 patients,13 patients were available for an average of 23.7 months（range,12-60）follow-up by the physical examination and MRI scan.Among them,12 patients（92.3%,12/13）were asymptomatic at the final followup interview,1 patient（7.7%,1/13）had recurrent locking of the knee.MRI images convinced that 11 meniscus（84.6%,11/13）completely healed,1（7.7%,1/13）partially healed and 1（7.7%,1/13）failed.Twelve repairs were assessed by second-look arthroscopy,confirming that 10 repairs（83.3%,10/12）completely healed,1（8.3%,1/12）partially healed and 1（8.3%,1/12）failed.Conclusion With a healing rate more than 90% by MRI and second-look arthroscopy,combined arthroscopic inside-out and all-inside repairing techniques（hybrid suture technique）was proven to be an effective method and suitable to treat the buckethandle tear of the lateral meniscus.