关节镜下前交叉韧带损伤合并ramp损伤的临床研究

Clinical study on anterior cruciate ligament injury complicated with ramp injury by arthroscopic treatment

目的探讨关节镜下前交叉韧带(ACL)损伤合并内侧半月板后角纵行破裂(ramp injury)的临床研究。方法回顾该科2005年1月～2010年6月前交叉韧带损伤合并半月板损伤的144例患膝的临床资料,急性期组(伤后6周内)79例,慢性期组(伤后6周～3年)65例。合并内侧半月板损伤71例,合并外侧半月板损伤55例,合并内外侧半月板损伤18例。经关节镜确诊为前交叉韧带损伤合并ramp损伤49例。其中,47例术中行移植自体四束股薄肌、半腱肌重建前交叉韧带,29例ramp损伤行半月板后角破裂处缝合,18例ramp损伤行半月板后角破裂处切除术。术前术后行Lysholm评分。结果急性期组79例,内侧半月板损伤分布占34.2%,外侧半月板损伤分布占49.4%,内外侧半月板损伤分布占16.5%,ramp损伤发病率21.5%。慢性期组65例,内侧半月板损伤分布占67.7%,外侧半月板损伤分布占24.6%,内外侧半月板损伤分布占7.7%,ramp损伤发病率49.2%。慢性期组ramp损伤发病率高于急性期组(P<0.01)。前交叉韧带重建合并半月板缝合29例,术前评分(40.8±10.5)分,术后评分(87.±811.7)分。前交叉韧带重建合并半月板切除18例,术前评分(41.4±9.6)分,术后评分(67.8±9.6)分。两者组内手术前后比较,术后均优于术前(P<0.01)。前交叉韧带重建合并半月板缝合组优于前交叉韧带重建合并半月板切除组(P<0.01)。结论对于急性前交叉韧带损伤,早期行前交叉韧带重建可减少继发的ramp损伤。半月板缝合术是治疗ramp损伤的有效方法。

[Objective] To investigate the arthroscopic operation effect on anterior cruciate ligament injury complicated with ramp injury. [Methods] 144 knees of anterior cruciate ligament injury complicated with meniscus injury were retrospectively analyzed between 2005.1 to 2010.6. There were 79 knees of acute stage （within six weeks after injury） and 65 knees of chronic phase （six weeks to three years after injury）. All the knees included 71 knees of medial meniscus injury, 55 knees of lateral meniscus injury, and 18 knees of medial and lateral meniscus injury. Forty-nine knees were diagnosed of anterior cruciate ligament injury complicated with ramp by arthroseopy. Forty- seven knees were treated with anterior crueiate ligament reconstruction by autologous gracilis and semitendinosus transplantation and twenty-nine ramp injury knees of suturing on the meniscus injuries of posterior horns, eighteen ramp injury knees of resection on the meniscus injuries of posterior horns. All knees function was evaluated by Lysholm＇s score preoperatively and postoperatively. [ Results ] There were 79 knees of acute stage, 34.2% of medial meniscus injury, 49.4% of lateral meniscus injury, and 16.5% of medial and lateral meniscus injury. The incidence of ramp injury was 21.5%. There were 65 knees of acute stage, 67.7% of medial meniscus injury, 24.6% of lateral meniscus injury, and 7.7% of medial and lateral meniscus injury. The incidence of ramp injury was 49.2%. The ramp injury＇s incidence of chronic phase was better than acute stage （P 〈0.01）. There were 29 knees of anterioreruciate ligament reconstruction with suturing on the meniscus injuries. The Lysholm＇s score was （40.8±10.5） preoperatively, and （87.8±11.7） postoperatively. There were 18 knees of anterior cruciate ligament reconstruction with resection on the meniscus injuries. The Lysholm＇s score was （41.4±9.6） preoperatively, and （67.8 ±9.6） postoperatively. The Lysholm＇s score of intra-group comparison was that postoperative is better than preoperative （P 〈0.01）. The group of anterior cruciate ligament reconstruction with suturing on the meniscus injuries was better than anterior cruciate ligament reconstruction with resection on the meniscus injuries （P 〈0.01）. [ Conclusion] Anterior cruciate ligament reconstruction at early stage can reduce the secondary ramp injury for acute anterior cruciate ligament injury. Meniscorrhaphy is an effective therapy of ramp injury.