内侧副韧带拉花松解在膝关节内侧半月板后角撕裂关节镜手术中的应用

Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of medial meniscus in knee joint

目的:探讨在膝关节镜手术中,运用内侧副韧带(medial collateral ligament,MCL)拉花松解技术处理合并膝关节内侧间室紧张的内侧半月板后角(posterior horn of medial meniscus,PHMM)撕裂时的安全性和有效性。方法:2013年1月至2014年12月对32例合并膝关节内侧间室紧张的PHMM撕裂患者,均使用MCL拉花松解技术。用18号静脉穿刺针于MCL胫骨止点附近进行松解,同时取膝关节外翻位处理PHMM撕裂。术后第1天、4周、12周分别行外翻应力试验及双膝外翻应力位X线片评估MCL愈合情况。术后1,3,6个月随访,之后每半年随访1次,每次采用疼痛视觉评分(Visual Analogue Scales,VAS),Lysholm,Tegner和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分评价患侧膝关节功能。结果:32例患者均得到随访,随访时间24~36(平均28)个月。无1例MCL撕裂、股骨骨折、关节软骨损伤及神经血管损伤等并发症。双膝外翻应力位X线片内侧关节间隙测量:术后第1天健侧为(4.3±1.3)mm,患侧为(6.6±1.6)mm,二者比较差异有统计学意义(P<0.05);术后4周健侧为(4.2±1.5)mm,患侧为(5.5±1.2)mm,二者比较差异有统计学意义(P<0.05);术后12周健侧为(4.3±1.4)mm,患侧为(4.8±1.5)mm,二者比较差异无统计学意义(P>0.05)。VAS术前4.5±1.5,最终随访为1.7±1.0,二者比较差异有统计学意义(t=16.561,P<0.05);Lysholm评分术前为52.3±5.8,最终随访为93.2±6.3,二者比较差异有统计学意义(t=-41.353,P<0.05);Tegner评分术前为4.1±1.1,最终随访为5.5±0.6,二者比较差异有统计学意义(t=–18.792,P<0.05);IKDC主观评分术前为54.5±6.2,最终随访为93.8±4.5,二者比较差异有统计学意义(t=–38.253,P<0.05)。结论:MCL拉花松解是一种安全、有效的处理合并膝关节内侧间室紧张的PHMM撕裂的手术方法。

Objective： To explore the effectiveness and safety of pie-crusting the medial collateral ligament release （MCL） in treating posterior horn of medial meniscus （PHMM） tear in tight medial tibiofemoral compartment of knee joint. Methods： Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tihial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales （VAS）, Lysholm scores, Tegner scores and International Knee Documentation Committee （IKDC） scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months. Results： The mean follow-up was 28 （24-36） months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm （P〈0.05） at the 1st day, 5.5 mm and 4.2 mm （P〈0.05） in the 4th week and 4.8 mm and 4.3 mm （P〉0.05） at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up （t=16.561, P〈0.05）. Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final follow- up （t=-41.353, P〈0.05）. Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up （t=-18.792, P〈0.05）. IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up （t=-38.253, P〈0.05）. Conclusion： Pie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee joint.