全关节镜下深层内侧副韧带松解在内侧半月板后角撕裂修复中的应用

Application of pie-crusting technique of deep medial collateral ligament under arthroscopy in repairing posterior horn of medial meniscus tears

目的:探讨全关节镜下由内向外的多点针刺松解深层内侧副韧带(medial collateral ligament,MCL)技术治疗合并膝关节内侧间隙狭窄的内侧半月板后角(posterior horn of medial meniscus,PHMM)撕裂的安全性和有效性。方法:自2016年1月至2017年12月,将膝关节镜下手术治疗的61例(61膝)合并膝关节内侧间隙狭窄的PHMM损伤患者根据在术中显露PHMM区域的不同分为外翻组和松解组。外翻组28例,男12例,女16例;年龄27~60(35.75±7.57)岁;采用传统的外翻膝关节操作方法显露PHMM区域进行手术。松解组33例,男15例,女18例;年龄26~58(36.06±7.93)岁;采用MM-Ⅱ半月板外内缝合套装由内向外的多点针刺松解深层MCL技术显露PHMM区域进行手术。记录两组患者的手术时间,比较手术前后膝关节功能Lysholm评分及MCL损伤情况。结果:两组患者均获得随访,时间12~18(15.19±2.22)个月。术后切口均Ⅰ级愈合。两组患者PHMM解剖分型比较差异无统计学意义(P>0.05)。外翻组手术时间(83.32±5.01)min与松解组(50.06±3.67)min比较差异有统计学意义(P<0.05)。两组患者术后3个月Lysholm评分均较术前显著提高(P<0.05),且松解组的Lysholm评分总分高于外翻组(P<0.05)。按照Lysholm评分标准,外翻组优7例,良12例,中7例,差2例;松解组优19例,良10例,中4例;两组比较差异有统计学意义(P<0.05)。术中外翻组对MCL损伤情况(0度15例,Ⅰ度10例,Ⅱ度3例,Ⅲ度0例)明显高于松解组(0度28例,Ⅰ度5例,Ⅱ度0例,Ⅲ度0例),但术后1个月两组MCL损伤比较差异无统计学意义(P>0.05)。结论:全关节镜下由内向外的多点针刺松解深层MCL技术治疗合并膝关节内侧间隙狭窄的内PHMM撕裂,可有效扩大膝关节内侧间隙空间,缩短手术时间,减少MCL的损伤,临床疗效显著。

Objective:To explore effectiveness and safety of an inside-out,arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus(PHMM)tear in tight medial tibiofemoral compartment of knee joint.Methods:From January 2016 to December 2017,61 patients(61 knees)were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint,who were divided into valgus group and pie-crusting group according to exposure of PHMM region.There were 28 patients in valgus group,including 12 males and 16 females aged from 27 to 60 years old with an average age of(35.75±7.57)years old;who were performed conventional valgused knee to exporsure PHMM region.There were 33 patients in pie-crusting group,including 15 males and 18 females aged from 26 to 58 years old with an average age of(36.06±7.93)years old;who were treated with inside-out,arthroscopic deep MCL pie-crusting release technique with MM-Ⅱ meniscus suture package(Smith&Nephew).Operation time,preoperative and postopertaive Lysholm score of knee joint,injury of MCL between two groups were recorded and compared.Results:All patients were followed up from 12 to 18 months with an average of(15.19±2.22)months.The incisions were healed at stageⅠ.There were no statistical difference in anatomical classification of PHMM between two groups(P>0.05).There was difference in opertaion time between valgus group(83.32±5.01)min and pie-crusting group(50.06±3.67)min(P<0.05).Postopertaive Lysholm score of knee joint at 3 months in two groups were higher than that of before operation(P<0.05),and Lysholm total score of knee joint in pie-crusting group was higher than that of valgus group(P<0.05).Acocording to Lysholm score of knee joint,7 patients got excellent results,12 good,7 moderate and 2 poor in valgus group;19 patients got excellent results,10 good,4 moderate in pie-crusting group;and had difference between two groups(P<0.05).MCL injury of valgus group(15 patients with degree 0,10 patients with degree Ⅰ,3 patients with degreeⅡ,0 patient with degree Ⅲ)was higher than pie-crusting group(28 patients with degree 0,5 patients with degree Ⅰ,0 patient with degree Ⅱ,0 patient with degree Ⅲ)(P<0.05),while there was no differnce between two groups in MCL injury at 1 month after opertaion(P>0.05).Conclusion:The inside-out,arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace,shorten operation time,reduce injury to MCL and obtain good clinical efficacy.