关节镜下穿刺针改良缝合技术治疗半月板撕裂的临床疗效

Clinical Efficacy of Improved Puncture Needle Suture Technique under Arthroscopic on the Treatment of Meniscus Tear

目的:探讨关节镜下穿刺针改良缝合和Fast-Fix全内缝合技术在修复半月板撕裂患者中的临床效果。方法:回顾性分析2017年10月至2019年12月采用缝合技术修复半月板前角及体部损伤患者91例,纳入穿刺针改良缝合组患者47例,Fast-Fix组患者44例,记录患者术中有无神经血管损伤、术后有无感染及排异反应。记录临床结局指标:平均每针缝合时长、半月板术中修复失效率、术后修复失效率。并记录膝关节功能Lysholm评分和Tegner活动评级。术后12个月复查MRI,观察半月板愈合情况。结果:两组患者术中未出现神经血管损伤,术后未出现伤口感染及内固定排异反应,末次门诊随访时关节疼痛较术前明显改善,未出现关节绞锁及关节肿胀等;术中每针缝合时长比较差异有统计学意义(P<0.001),两组术中失效率、术后失效率比较差异无统计学意义(P>0.05)。末次随访时,术后失效并需再次手术的患者在穿刺针改良缝合组中有5例(11.36%),Fast-Fix组有6例(13.63%)。两组患者术前、术后12个月及末次随访时Lysholm评分和Tegner活动评级比较差异无统计学意义(P>0.05);术后12个月复查患膝MRI示半月板愈合情况可。结论:采用关节镜下穿刺针改良缝合临床疗效肯定,并且术中无需特殊器械,操作简易,值得临床推广应用。

Objective:To investigate the clinical efficacy of modified puncture needle suture under arthroscopic and Fast-Fix total internal suture in repairing meniscus tear.Methods:A total of 91patients with meniscus anterior horn and body injury repaired by suture were retrospectively analyzed.47patients were included in the modified puncture and suture group and 44patients in the Fast-Fix group.Intraoperative neurovascular injuries,postoperative infections and rejection were recorded.The clinical outcome indexes including surgical average suture time per needle,intraoperative failure rate of meniscus repair and postoperative repair failure rate were recorded.Additionally,Lysholm score and Tegner activity rating of knee function were recorded.The healing situation of the meniscus was observed by MRI 12months after surgery.Results:No intraoperative neurovascular injury,postoperative wound infection or fixed rejection occurred in the two groups.At the last outpatient follow-up,the joint pain was significantly improved compared with that before surgery,without interlocking or swelling joints.Surgical intraoperative suture time per needle showed statistically significant differences between the two groups(P<0.001).However,no statistically significant differences was found in intraoperative or postoperative failure rate between the two groups(P>0.05).At the last follow-up,there were 5(11.36%)patients in the modified outside-in puncture and suture group and 6(13.63%)patients in the Fast-Fix group with postoperative failure and needing secondary surgery.Lysholm score and Tegner activity rating presented no statistically significant differences between the two groups before surgery,12months after surgery and at the last follow-up(P>0.05).The knee MRI 12months after surgery displayed that the healing of the meniscus was satisfactory.Conclusion:The modified arthroscopic puncture needle suture presents good clinical efficacy,and it needs no special instruments during surgery and simple operation.Therefore,it is worthy of clinical promotion.