关节镜下改良outside-in穿刺缝合技术修复半月板撕裂的中期临床随访

A mid-term clinical follow-up study on repair of the meniscus tears by a modified arthroscopic outside-in puncture suture technique

目的:探讨关节镜下利用腰椎穿刺针结合outside-in缝合技术治疗膝关节半月板撕裂的临床疗效。方法:选择2015年1月至2017年10月因半月板撕裂采用关节镜下利用腰椎穿刺针结合outside-in缝合技术治疗的患者的病例资料进行回顾性分析。共纳入病例95例,男36例,女59例;年龄16~77岁,平均(46.79±18.07)岁;左侧53例,右侧42例,致伤原因包括运动、扭伤等。根据Barrett标准判断半月板临床愈合情况,采用Lysholm评分、膝关节活动度、视觉模拟评分(visual analogue scale,VAS)、膝关节磁共振对患者术后膝关节功能及康复情况进行评估。结果:95例患者随访时间22~36个月,平均(28.32±3.98)个月。根据Barrett标准,90例(94.7%)患者获得半月板临床愈合。对比术前与术后患者膝关节Lysholm评分、关节活动度和VAS评分,差异均有统计学意义(P<0.01)。随访过程中未发现手术部位感染、关节周围血管神经损伤、线结反应等并发症。结论:采用关节镜下腰椎穿刺针结合outside-in缝合技术治疗半月板前角及体部撕裂具有操作简单、创伤小、恢复快的特点,临床效果满意,可能是治疗半月板前角及体部撕裂的有效办法。

Objective:To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle.Methods:From January 2015 to October 2017,95 patients treated with this method were followed-up.Among these cases,there were 36 males and 59 females.The age of the patients ranged from 16 to 77 years,(46.79±18.07)years in average.Among them,there were 28 patieats aged 16-35,53 patients aged 36-65,and 14 patients aged over 65 years old.28 cases were diagnosed with medial meniscus tear,43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear.Causes of the injury included sports,sprain,etc.According to Barrett standard,the clinical healing of meniscus tear was judged.Lysholm score,knee range of motion,visual simulation score(VAS)and magnetic resonance imaging(MRI)were used to evaluate the postoperative knee function and recovery of the patients.Results:The 95 patients were followed up for 22 to 36 months,with an average of(28.32±3.98)months.According to Barrett standard,90 patients(94.7%)obtained meniscus clinical healing.Meniscal healing rates were 96.43%,96.23%and 85.71%in the three age groups,respectively.The meniscal healing rate was lower in the elderly group,but there was no significant difference in statistical results(P=0.262).Five patients had deep tenderness in the joint space of the injured side,and the overstretch test was positive.The preoperative and postoperative VAS scores,Lysholm scores and knee motion were compared in each group,and the differences were statistically significant(P<0.01).At the end of the last follow-up,there were no cases of knee joint effusion,swelling and interlocking,and the joint function was effectively improved in most patients.No surgical site infection,periarticular vascular/nerve injury or knotting reaction was found during the follow-up.Conclusion:This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation,small trauma and rapid recovery,and the mid-term follow-up results were satisfactory.Therefore,we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.