肩袖缝线过线器在缝合半月板水平撕裂损伤中的应用

Application of rotator cuff suture threader in horizontal tear of meniscus

目的探讨使用肩袖缝线过线器在缝合半月板水平撕裂中的应用。方法选取2012年6月—2015年6月收治的半月板水平撕裂损伤患者17例,其中男性12例,女性5例;年龄18~45岁,平均26.7岁。所有病例均合并前交叉韧带断裂,采用腰硬联合麻醉,关节镜下使用肩袖缝线过线器缝合半月板水平撕裂伤,再重建前交叉韧带。术前术后采用VAS评分、临床查体及Lysholm评分进行疗效评价。结果 1例内侧体部及1例内侧后角水平撕裂伤患者由于关节间隙太小,行内侧松解后成功缝合,此2例患者在缝合过程中对股骨软骨造成轻微损伤,1例内侧后角损伤患者即使行内侧松解后仍因间隙太小无法缝合后改为其他缝合方法,其余患者均成功缝合,无并发软骨损伤。所有患者分别于术后1、3、6、12个月得到随访,末次随访时13例主观症状及临床查体正常,3例有活动后轻度胀痛但查体无异常,1例活动后中度疼痛伴关节间隙压痛。末次随访时患者VAS评分由术前(4.6±1.2)分下降至术后(1.2±0.4)分,Lysholm评分由术前(63.9±8.7)分提高到(93.4±5.0)分,有统计学意义(P<0.01)。结论关节镜下使用肩袖缝线过线器可以对大部分的半月板水平撕裂进行全内缝合,尤其是体部水平撕裂,且无不良并发症,具有手术操作方便、并发症少、价格低廉、愈合率高的优点。

Objective To study the availability of rotator cuff suture threader in horizontal tear of meniscus.Methods Seventeen patients with horizontal injury of meniscus were treated in our hospital from Jun.2012 to Jun.2015,including 12 males and 5 females,with an average age of 26.7 years(range,18-45).All patients were combined with anterior cruciate ligament rupture and applied with spinal-epidural anesthesia to conduct arthroscopic surgery.The horizontal tear of meniscus was sutured using the rotator cuff suture threader,followed by rebuilding the anterior cruciate ligament.VAS and Lysholm score were used for evaluation of knee joint preoperatively and postoperatively.Results Due to small joint space,1 case of medial body meniscus horizontal tear and 1 case of medial posterior meniscus horizontal tear were successfully sutured until release of medial collateral ligament.But the two patients suffered minor damage to the femur cartilage.One case of medial posterior meniscus horizontal tear was sutured by another method because of small joint space even after release of medial collateral ligament.All cases were followed up at 1 month,3 months,6 months and 12 months after surgery.At the final follow-up,subjective symptoms and clinical examination were normal in 13 cases,3 patients had mild pain after activity,and 1 case had moderate pain with joint space tenderness.At the end of the follow-up,the VAS score was decreased to(1.2±0.4)points from(4.6±1.2)points,the Lysholm score was improved to(93.4±5.0)points from the preoperative(63.9±8.7)points,and the efficacy was satisfactory.Conclusion Rotator cuff suture threader could be used to suture the horizontal tear of meniscus,especially the horizontal tearing of meniscus body.This method has advantages such as easy operation,few complications,low cost and high healing rate.