关节镜下全内联合外-内“环抱”式缝合法治疗半月板桶柄样撕裂疗效观察

Clinical observation of arthroscopic all-inside combined with outside-in“suture loop”repair for meniscus bucket-handle tear

目的观察并探讨关节镜下全内联合外-内"环抱"式缝合法治疗半月板桶柄样撕裂(buckethandle tear,BHT)的疗效。方法2016年8月—2019年5月,采用关节镜下全内联合外-内"环抱"式缝合法治疗44例膝关节半月板BHT患者,其中男29例,女15例;年龄18~42岁,平均26.6岁。致伤原因:运动损伤31例,高处坠落伤7例,扭伤6例。内侧半月板后角损伤32例,外侧半月板后角损伤12例。病程6周~3个月。合并前交叉韧带断裂33例。所有患者下肢力线均正常。患者术前Lysholm评分为(42.1±9.1)分。根据术后MRI及Barrett等的评价标准评估半月板愈合情况,采用Lysholm评分评价疗效。结果术后44例患者均获随访,随访时间8~36个月,平均16.8个月。末次随访时,根据Barrett等的评价标准获临床愈合39例、未愈合5例,临床愈合率88.6%;MRI评估完全愈合32例、部分愈合7例、未愈合5例,总愈合率88.6%,完全愈合率72.7%。Lysholm评分为(87.8±4.8)分,与术前比较差异有统计学意义(t=31.060,P=0.000)。结论关节镜下全内联合外-内"环抱"式缝合法是治疗半月板BHT可靠、有效的方法,能获得良好的关节功能。

Objective To investigate the effectiveness of arthroscopic all-inside combined with outside-in"suture loop"repair for meniscus bucket-handle tear(BHT).Methods Between August 2016 and May 2019,44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in"suture loop".There were 29 males and 15 females with an average age of 26.6 years(range,18-42 years).The causes of injury included sports injury in 31 cases,falling injury in 7 cases,and sprain in 6 cases.There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears.The disease duration ranged from 6 weeks to 3 months.Thirty-three cases were complicated with anterior cruciate ligament rupture.All patients had normal lower limb alignment.The preoperative Lysholm score was 42.1±9.1.According to the evaluation criteria of MRI and Barrett et al.,the healing of meniscus was evaluated,and the effectiveness was evaluated by Lysholm score.Results All the 44 patients were followed up 8-36 months with an average of 16.8 months.At last follow-up,according to the evaluation criteria of Barrett et al.,39 cases were clinically healed,5 cases were not healed,the clinical healing rate was 88.6%;according to MRI evaluation,32 cases were completely healed,7 cases were partially healed,and 5 cases were not healed,the total healing rate was 88.6%,and the complete healing rate was 72.7%.Lysholm score was 87.8±4.8,which was significantly different from that before operation(t=31.060,P=0.000).Conclusion Arthroscopic all-inside combined with outside-in"suture loop"repair is a reliable and effective method for the meniscus BHT,which can obtain good joint function.