胫骨高位截骨联合内侧半月板后根部修复术的早期疗效及二次关节镜下探查结果

Short-term clinical outcomes and second-look arthroscopic findings of high tibial osteotomy combined with medial meniscus posterior root repair

目的探讨胫骨高位截骨联合内侧半月板后根部修复术治疗膝内翻型骨关节炎合并内侧半月板后根部撕裂的临床疗效及内侧半月板后根部修复的预后。方法回顾性分析2015年6月至2017年9月接受高位胫骨截骨联合内侧半月板后根部修复术并行二次关节镜检查的患者25例,男6例,女19例;年龄(56.60±5.65)岁(范围49~69岁)。诊断均为内侧间室骨关节炎合并膝内翻畸形,伴内侧半月板后根部撕裂。关节镜探查后行双平面胫骨高位截骨联合内侧半月板后根部修复,胫骨高位截骨在冠状面调整下肢机械轴至通过胫骨平台外侧62.5%的位置,通过经胫骨隧道拉出法修复内侧半月板后根部。术前及末次随访时摄双下肢负重位全长X线片,评估Kellgren-Lawrence分级、测量下肢机械轴通过胫骨平台的相对位置;摄MRI片测量内侧半月板的相对外突程度;取内固定术时行二次关节镜探查,评估软骨再生及内侧半月板后根部愈合情况;通过特种外科医院(Hospital for Special Surgery,HSS)评分、Lysholm评分评估膝关节功能。结果经二次关节镜探查,内侧半月板后根部完全愈合12例(48%,12/25),部分愈合9例(36%,9/25),瘢痕愈合3例(12%,3/25),不愈合1例(4%,1/25);软骨再生Ⅰ级9例,Ⅱ级7例,Ⅲ级9例。随访时间(13.04±1.06)个月(范围12~16个月)。末次随访时,Kellgren-Lawrence分级与术前比较差异无统计学意义(χ2=0.786,P=0.675);下肢机械轴通过胫骨平台的相对位置由术前19.88%±6.44%改善至58.68%±7.71%(t=-18.561,P<0.001);内侧半月板相对外突程度术前51.12%±13.55%,术后50.48%±15.15%,差异无统计学意义(t=0.550,P=0.588);Lysholm评分由术前(34.76±3.62)分提高至(82.08±4.35)分(t=-52.717,P<0.001);HSS评分由术前(33.52±6.48)分提高至(81.52±4.79)分(t=-38.685,P<0.001)。不同半月板后根部愈合程度组影像学资料及临床评分的差异无统计学意义;不同软骨再生程度组影像学资料及临床评分的差异无统计学意义。结论胫骨高位截骨联合内侧半月板后根部修复术可以有效改善下肢力线、缓解症状,经关节镜二次探查证实内侧间室软骨再生及内侧半月板后根部愈合满意。半月板后根部愈合程度及软骨再生程度对术后早期疗效没有影响。

Objective To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy(HTO)combined with medial meniscus posterior root(MMPR)repair.Methods Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed.Biplane HTO combined with MMPR repair was performed on these patients.Arthroscopic transtibial pullout repair was employed to repair the MMPR.The relative degree of the medial meniscus extrusion(MME)were measured.Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy.Clinical outcomes were assessed based on Hospital for Special Surgery(HSS)scores and Lysholm scores.Results The MMPRs were completely healed in 12 cases(48%),partially healed in 9 cases(36%),healed with scarring in 3 cases(12%),and no healed in 1 case(4%).Follow-up duration was 13.04±1.06 months(12-16 months).There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery(χ2=0.786,P=0.675).The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88%±6.44%preoperatively and 58.68%±7.71%after operation with significant difference(t=-18.561,P<0.001).The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation(t=-52.717,P<0.001).The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation(t=-38.685,P<0.001).The degree of MME was changed from 51.12%±13.55%to 50.48%±15.15%without statistical difference(t=0.550,P=0.588).The comparison between different degrees of healing groups revealed no statistical differences in all variables(P>0.05).The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables(P>0.05).Conclusion HTO combined with MMPR repair can effectively improve the lower limb alignment and patients'symptoms with a satisfactory healing rate of MMPR.The effects of post-root repair after a short period is not obvious.The longer-term clinical effects is worthy of further observation.