新型半月板过线器包绕缝合与传统全内缝合器缝合修复外侧半月板腘肌腱裂孔区损伤的比较

Application of meniscus suture wrapped by suture device versus traditional total internal suture device in the treatment of lateral meniscus popliteal tendon injury

背景:为了更好地保留外侧半月板的环状结构、最大限度地保留膝关节功能,目前关节镜下修复外侧半月板腘肌腱裂孔区损伤常用的缝合方法有全内缝合和由内向外缝合两种技术,均存在一定的不足。目的:探讨关节镜下半月板过线器包绕缝合法与传统全内缝合器缝合法修复外侧半月板腘肌腱裂孔区损伤的临床疗效差异。方法:选择2019年1至12月佛山市中医院收治的关节镜下缝合修复外侧半月板腘肌腱裂孔区损伤的患者84例,年龄23-32岁,分为半月板过线器包绕缝合组(n=40)和全内缝合器缝合组(n=44)。收集两组患者的手术时间、缝合针数及住院总费用等资料,手术前后采用IKDC评分、Lysholm评分和Tegner评分评价患者膝关节功能,同时术后采用Barrett评价标准、MRI检查、二次关节镜探查评估半月板愈合情况。研究获得佛山市中医院伦理委员会批准,伦理批件号20191230。结果与结论:①84例患者术后切口均Ⅰ期愈合,无关节感染、异物排斥等并发症,术后随访12-24个月;两组缝合针数和手术时间比较差异无显著性意义(P>0.05),过线器包绕缝合组住院费用低于全内缝合器缝合组(P<0.05)。②两组末次随访的IKDC评分、Lysholm评分、Tegner评分比较差异无显著性意义(P>0.05)。③末次随访时,根据Barrett评价标准,两组临床愈合率比较差异无显著性意义(P>0.05);末次随访复查MRI显示,两组完全愈合率、总愈合率比较差异均无显著性意义(P>0.05)。④36例患者(过线器包绕缝合组18例,全内缝合器缝合组18例)于术后12-24个月行二次关节镜探查,两组完全愈合率、总愈合率比较差异均无显著性意义(P>0.05)。⑤结果表明,采用半月板过线器包绕缝合法修复外侧半月板腘肌腱裂孔区损伤是一种安全可靠、经济实用、疗效确切的治疗方法。

BACKGROUND:To preserve the annular structure of the lateral meniscus and the function of the knee joint as much as possible.At present,there are two kinds of suture methods commonly used in arthroscopic repair of lateral meniscus popliteal tendon hiatus area injury:total internal suture and inside-out suture.All of them have some shortcomings.OBJECTIVE:To investigate the difference of clinical efficacy between arthroscopic meniscal suture with suture device wrapping and total internal suture device in repairing lateral meniscus popliteal tendon hiatus injury.METHODS:Totally 84 patients with lateral meniscus popliteal tendon injury treated in the Foshan Hospital of Traditional Chinese Medicine from January to December 2019 were enrolled in this study.The patients,aged 23-32 years,were divided into two groups:the meniscus suture passer group(n=40)and total internal suture device group(n=44).The operation time,the number of stitches and the total cost of hospitalization were collected in the two groups.IKDC score,Lysholm score and Tegner score were used to evaluate knee joint function before and after operation.Simultaneously,Barrett evaluation criteria,MRI examination and secondary arthroscopic exploration were used to evaluate the meniscus healing.This study was approved by Ethics Committee of Foshan Hospital of Traditional Chinese Medicine(approval No.20191230).RESULTS AND CONCLUSION:(1)The incisions of 84 patients healed in the first stage after operation,and there were no complications such as joint infection or foreign body rejection.The patients were followed up for 12-24 months.There was no significant difference in the number of suture needles and operation time between the two groups(P>0.05).The cost of hospitalization in the meniscus suture passer group was lower than that in the total internal suture device group(P<0.05).(2)There was no significant difference in IKDC score,Lysholm score,and Tegner score between the two groups at the last follow-up(P>0.05).(3)At the last follow-up,according to Barrett’s evaluation criteria,there was no significant difference in the clinical healing rate between the two groups(P>0.05).At the last follow-up,MRI showed that there was no significant difference in the complete healing rate and total healing rate between the two groups(P>0.05).(4)Thirty-six patients(18 cases in the meniscus suture passer group and 18 cases in the total internal suture device group)underwent secondary arthroscopic exploration at 12-24 months after surgery.There was no significant difference in the complete healing rate and total healing rate between the two groups(P>0.05).(5)The conclusion shows that using meniscus suture passer to repair the injury of popliteal tendon hiatus of lateral meniscus is a safe,reliable,convenient,and effective method,has high healing rate.