前交叉韧带合并半月板损伤同期修复139例随访报告

A following-up report of 139 patients with simultaneous repair of anterior cruciate ligament combined with meniscus injury

目的探讨前交叉韧带（anterior cruciate ligament,ACL）合并半月板损伤同期修复的临床疗效。方法对2005年10月至2013年12月,我院经治的139例ACL合并半月板损伤患者,进行随访。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天-1.6年。临床主要表现为膝关节不稳,疼痛,弹响,绞锁。本组均采用同期ACL重建合并半月板缝合术治疗,术前、术后采用Lysholm评分及IKDC评分评价膝关节功能,根据Barrett标准评判半月板愈合情况。结果本组139例,术后切口均I期愈合,术后无血管、神经等并发症发生。139例均随访11个月-9年,平均3年,术后3、6、12、24、36个月Lysholm评分依次为：62.36±3.24,79.46±1.28,88.64±4.06,94.36±2.42,94.48±4.28较术前（32.66±3.42）明显提高（P3=0.000,P6=0.000,P12=0.000,P24=0.000,P36=0.000）,术后3、6、12、24、36个月IKDC评分依次为：68.86±2.38,80.05±0.91,90.48±3.66,95.56±3.28,96.64±3.36,较术前（38.48±4.32）明显改善（P3=0.000,P6=0.000,P12=0.000,P24=0.000,P36=0.000）。半月板愈合136例,3例陈旧性桶柄状撕裂术后有活动后中度疼痛,愈合率97.84%。结论 ACL合并半月板损伤应早期修复;同期修复ACL合并半月板损伤术后膝关节功能恢复好,愈合率高,临床效果满意。

Objective To explore clinical effects of simultaneous anterior cruciate ligament（ ACL） reconstruction and meniscus suture. Methods One hundred and thirty-nine patients with ACL and meniscus injury being admitted into our hospital from October, 2005 to December, 2013 were studied, including 98 males and 41 females. The average age was 31.2 years old（ range： 13-71 years）. There were 62 left knees, 77 right knees with the course of disease 5 days-1.6 years. All patients were performed ACL reconstruction and meniscus suture simultaneously. Main clinical manifestations were knee joint instability, pain, joint clicking, and locking. Results were assessed by Lysholm and IKDC knee-joint score system before and after operations. Barrett standard was used to evaluate clinical effects. Results All incisions healed primarily, no neurological or vascular injury were found. All 139 patients were followed up with the mean period of 3 years（ range： 11 months-9 years）. Lysholm increased from 32.66±3.42 to 62.36±3.24 3 months after the operation, 6 months to 79.46±1.28, 12 months to 88.64±4.06, 24 months to 94.36±2.42, 36 months to 94.48±4.28（ P3=0.000, P6=0.000, P12=0.000, P24=0.000, P36=0.000）. IKDC increased from 38.48±4.32 to 68.86±2.38 3 months after the operation, 6 months to 80.05±0.91, 12 months to 90.48±3.66, 24 months to 95.56±3.28, 36 months to 96.64±3.36（ P3=0.000, P6=0.000, P12=0.000, P24=0.000, P36=0.000）. Meniscus healed in 136 cases. Three cases of chronic bucket-handle tears had moderate pain after exercises postoperatively. Healing rate was 97.84%. ConclusionsACL and meniscus injury should be repaired at early stage. Simultaneous ACL reconstruction combined with meniscus suture has better post-operative joint functions and higher healing rate. Clinical effects are satisfactory.