关节镜下半月板缝合术治疗中年人半月板损伤的疗效评估

Clinical results of arthroscopic suture for meniscal tear in middle aged adults

目的：观察关节镜下半月板缝合术治疗中年人半月板损伤的临床疗效及愈合情况。方法 ：自2014年3月至2015年1月,对40例符合纳入标准的中年膝关节半月板损伤患者采用关节镜下半月板缝合术进行治疗,男24例,女16例;平均年龄（52.65±3.63）岁（50-60岁）;左膝28例,右膝12例;屈曲角（117.50±7.16）°（110°-130°）。术前膝关节Lysholm评分54.30±14.72（23-71分）,IKDC评分50.65±15.95（18-78分）,WOMAC评分23.80±19.39（2-75分）。均采用关节镜下全关节内半月板缝合术,术后以临床评分及MRI检查来评估疗效。结果：所有手术成功,未见严重并发症。术后随访6-12个月,无失访病例。所有患者保持5级肌力,膝关节活动度正常,能完全伸直及完全屈曲。40例平均屈曲角（125.00±5.13）°（110°-130°）,较术前改善（t=-3.47,P=0.003）。终末随访膝关节Lysholm、IKDC及WOMAC评分分别为79.50±8.70（t=-7.790,P=0.000）,79.40±10.40（t=-8.431,P=0.000）,8.15±6.77（t=3.988,P=0.001）,均较术前改善。MRI随访完全愈合4例,部分愈合22例,未愈合14例。损伤较小缝合3针及以下者,不愈合率为27.3%（6/22）;损伤较大缝合大于3针者,不愈合率为44.4%（8/18）。结论：关节镜下半月板缝合术治疗中年人单纯半月板损伤疗效良好。术后不愈合率达35%,中年人半月板愈合能力较差。损伤较小者愈合率相对较高,损伤越大愈合率越低。

Objective：To observe the clinical result and healing of meniscal suture under arthroscopy for the treatment of the middle aged patients with meniscal injury. Methods：From March 2014 to January 2015,40 middle aged patients included in the standard with injury of meniscus,which were repaired by meniscal suture technique under arthroscopy,involving 24 males and 16 females with an average age of（52.65±3.63） years ranging from 50 to 60 years;28 cases were on left knee,12 cases were on right knee. Average flexion angle averaged（117.50±7.16） ° ranging from 110° to 130°. Lysholm knee score averaged 54.30±14.72 ranging from 23 to 71;IKDC score averaged 50.65±15.95 ranging from 18 to 78;the WOMAC score averaged 23.80±19.39 ranging from 2 to 75. All-inside meniscus suture under arthroscopy was performed. Results：All operations were successful without serious complications. Postoperative follow-up was 6 to 12 months,none of the patients lost to followup. All patients maintain a category 5 degree muscle strength,normal knee joint mobility,can completely straight and completely buckling. Average flexion angle was（125.00±5.13） °（110° to 130°）（t=3.47,P=0.003）. Final Lysholm scale,IKDC scores and WOMAC scores averaged 79.50±8.70（t=7.790,P=0.000）,79.40±10.40（t=8.431,P=0.000）,8.15±6.77（t=3.988,P=0.001） separately. Follow up MRI showed that meniscus healed in 4 cases,partially healed in 22 cases,haven＇t healed in 14 cases. Failure rate of small lesion was 27.3%（6 / 22）,and failure rate of large lesion was 44.4%（8 / 18）. Conclusion：Clinical effect of meniscal suture under arthroscopy for the treatment of the middle aged is good. The failing rate was 35% because of healing ability is poor in middle aged adults. Failure rate of large lesion was higher than that of small lesion.