关节镜辅助内侧副韧带浅层松解在内侧半月板损伤修复中的应用

The Application of Pie-crusting Technique of Superficial Medial Collateral Ligament under Arthroscopy in Repairing Medial Meniscus Tears

目的:对内侧半月板后角损伤的患者,采用关节镜下缝合修复方法,辅助内侧副韧带浅层结构局部松解,观察其术后疗效。方法:2014年3月至2014年10月,连续37例患者入选本研究。男23例,女14例,平均年龄36.7±9.2岁。单纯内侧半月板损伤6例,前交叉韧带合并内侧半月板损伤31例。缝合修复半月板时,对内侧副韧带浅层结构的后方纤维进行松解。半月板修复均采用自内向外缝合方法。术后随访时评估患者主观症状,有无关节交锁、内侧关节间隙疼痛,有无压痛,内侧副韧带稳定性。拍摄膝关节核磁共振片了解半月板愈合情况。结果:37例患者平均获得26.1±4.4个月的随访。31例患者为前交叉韧带损伤合并内侧半月板损伤,术后随访时膝关节稳定性KT-1000检查侧-侧差值平均为1.3±0.7 mm,与术前(7.1±2.2 mm)相比有显著差异(P<0.01)。另6例患者接受单纯半月板缝合修复,膝关节无不稳定表现。全部患者膝关节内侧稳定性术后较术前无显著差异。3例患者主诉内侧关节间隙疼痛,无交锁现象。术后核磁共振片显示内侧半月板愈合率为81.1%。结论:关节镜下缝合修复方法治疗内侧半月板损伤,术后平均随访26.1个月,愈合率为81.1%。术中辅助内侧副韧带浅层组织局部松解,可以改善视野、提高操作效率,术后患者无内侧结构不稳定表现。

Objective To evaluate the clinical outcomes of repairing medial meniscus tears using pie-crusting of the superficial medial collateral ligament（MCL）under the arthroseopy. Methods From March 2014 to October 2014,37 consecutive cases were included in this study. Among all of the patients,23 were male, 14 were female,with an average age of 36.7±＋9.2 years. Six of the 37 patients were only of medial meniscus tears,while the other 31 were combined with anterior crueiate ligament （ACL） injuries. Pie-crusting technique of MCL was used and the suturing of meniscus tears was performed from the in- side to outside. All patients were followed up about their subjective symptoms,MCL stability and wheth- er they had joint interlocking,pain in the medial joint space and pressing pain. MRI was conducted to evaluate the healing status of the meniscus. Results The mean follow-up period was 26.1±4.4 months. For all of the patients, there was no instability in the medial compartment of the knee joints. For 31 patients receiving ACL reconstruction and medial meniscus repair, the Laehman test of the injured knee after the surgeries indicated a mean side to side difference of 1.3＋0.7 ram,with significant improvement compared with preoperative resuhs （7.1±2.2 mm）（P〈0.01）. Three patients complained tenderness at the medial side of the knee without locking. It was found from MRI the healing rate of the meniscus was 81.1%. Conclusion The healing rate after arthroscopic repair of the medial meniscus tears was 81.1% with a mean follow-up period of 26.1 months. Pie-crusting in superficial MCL helped to enlarge the medial compartment of the knee and promote operative efficiency during the surgeries. There was no unstable medial compartment of the knee joints after the surgeries.