两种松解技术镜下治疗内侧半月板后角损伤

Comparison of two pie-crusting techniques for arthroscopic treatment of posterior horn medial meniscus tears

[目的]比较两种内侧副韧带(medial collateral ligament,MCL)松解技术治疗内侧半月板后角撕裂的临床效果。[方法]回顾性分析2016年1月~2018年6月56例接受膝关节镜手术治疗的内侧半月板后角撕裂患者。其中,26例采用由外向内松解技术,30例采用由内向外松解技术。比较两组围手术期、随访与影像资料。[结果]56例患者均顺利完成手术。相比内-外组,外-内组手术耗时短,但早期松解相关并发症多(P<0.05)。与术前相比较,末次随访时两组患者活动时VAS评分显著下降(P<0.05),而Lysholm评分显著增加(P<0.05);相应时间点,两组间活动时VAS评分和Lysholm评分的差异均无统计学意义(P>0.05)。MRI检查显示,末次随访时两组患者半月板愈合程度的差异无统计学意义(P>0.05)。两组患者内侧室股骨髁与胫骨平台软骨退变程度差异无统计学意义(P>0.05)。[结论]关节镜下两种MCL松解技术均能有效扩大膝内侧关节间隙,便于处理内侧半月板后角撕裂,术后近期疗效满意。

[Objective]To compare the clinical outcome of two pie-crusting techniques in arthroscopic treatment of posterior horn medial meniscus tears.[Methods]A retrospective study was conducted on 56 patients who underwent arthroscopic treatment for posterior horn medial meniscus tears from January 2016 to June 2018.Of them,26 patients received the outside-in release of the medial collateral ligament(MCL),while the remaining 30 patients had the MCL released by the inside-out technique.The perioperative,follow-up and MRI data were compared between the two groups.[Results]All the 56 patients underwent successful surgical procedures.The outside-in group consumed significantly shorter operation time,whereas had significantly higher incidence of complications related to the MCL release than the inside-out group(P<0.05).The VAS score in activity significantly decreased,while the Lysholm score significantly increased at the latest follow up compared with those before operation in both groups(P<0.05).However,there were no statistical differences in the aforesaid two scores between the two groups at any corresponding time point(P>0.05).As consequence of MRI examination,no a statistically significant difference was noted in neither healing grade of the medial meniscus,nor osteochondral degeneration scale of the medial femoral condyle and tibial plateau between the two groups(P>0.05).[Conclusions]Both the outside-in and inside-out pie-crusting techniques are effective to enlarge working space for arthroscopic procedures,and achieve satisfactory clinical outcomes for posterior horn medial meniscus tears.