前交叉韧带合并不同类型半月板损伤的治疗策略

Treatment strategy of ACL injury associated with various meniscus injuries

背景：前交叉韧带合并半月板损伤临床常见，针对不同的损伤类型，采取不同的治疗策略，对术后膝关节功能恢复至关重要。目的：研究前交叉韧带合并半月板不同损伤类型的特点，探讨相应的治疗策略。 方法：选取2005年10月至2013年12月期间收治的前交叉韧带合并半月板损伤患者139例，男98例，女41例；年龄13-71岁，平均31.2岁；左膝62例，右膝77例，病程5 d至1.6年，陈旧性损伤（病程＞3周）32例，新鲜性损伤（病程≤3周）107例。患者均有外伤史。临床主要表现为膝关节不稳、疼痛、弹响、绞锁。将术中镜下影像资料进行分析，统计前交叉韧带合并半月板损伤的类型特征及手术方式。 结果：所有病例均采用关节镜微创手术治疗，前交叉韧带完全断裂113例，部分断裂26例。外侧半月板损伤46例（盘状半月板损伤8例，胫骨髁间棘撕脱2例）占33.1%，内侧半月板损伤65例（46.7%），内外侧半月板同期损伤28例（20.2%）。半月板纵行撕裂42例（桶柄状撕裂24例），水平状撕裂8例，斜行撕裂36例，瓣状撕裂13例，横断性撕裂12例，复合性撕裂28例。前交叉韧带重建139例，半月板部分切除36例，半月板缝合103例。 结论：陈旧性前交叉韧带合并半月板损伤以外侧半月板多见，急性损伤以内侧半月板损伤为主。内外侧半月板同期损伤多见于陈旧性损伤。陈旧性损伤多数需要半月板部分切除，急性损伤多数可以缝合。前交叉韧带合并半月板损伤应早期手术。

Background：Anterior cruciate ligament （ACL） combined with meniscus injuries is a common disease in clinic. It is very im-portant to take different treatment therapies for different types of injury. Objective：To study the features of the combined injury of ACL and meniscus and to explore its treatment strategies Methods：A total of 139 patients with ACL and meniscus injury admitted into our hospital from October 2005 to December 2013. There were 98 males and 41 females with a mean age of 31.2 years （range, 13-71 years）. The left knee was affected in 62 cases and the right knee was injured in 77 cases. The course of disease ranged from 5 days to 1.6 years. The injury was chronic （duration〉3 weeks） in 32 cases and fresh （duration≤3 weeks） in 107 cases. All patients had a history of trauma. The main clinical manifestations included knee joint instability, pain, joint clicking and locking. The features of injury and the mode of operation were analyzed according to arthroscopic video images. Results：All patients were treated under arthroscopy. There were 113 patients with complete ACL rupture and 26 with partial rupture. The lateral meniscus injury （discoid meniscus injury in 8 cases, tibial eminence fracture in 2） occurred in 46 cases （33.1%）. The medial meniscus injury happened in 65 cases （46.7%）. The lateral and medial combined injury was found in 28 cases （20.2%）. Longitudinal tear was found in 42 cases （bucket-handle tear in 24）, horizontal in 8, oblique in 36, flap shaped in 13, cross-sectional in 12, and compound in 28. There were 139 patients treated with ACL reconstruction, 36 with partial meniscectomy, and 103 with meniscus suture repair. Conclusions：Chronic combined injury of ACL and meniscus often occur in lateral meniscus, while acute injury is mainly in medial meniscus. The homochronous injury of medial and lateral meniscuses is often chronic. It usually needs to undergo partial meniscectomy for chronic injuries, and suturing is essential for acute ones. The combined injury of ACL and menis-cus should be treated as early as possible.