关节镜下外-内-外缝合治疗半月板撕裂的临床效果观察

Treatment of meniscal tear with outside-inside-out suture under knee arthroscope

目的探讨膝关节镜下采用外-内-外法缝合治疗半月板撕裂的临床效果。方法选取2014年10月至2021年10月河南省洛阳正骨医院(河南省骨科医院)收治的66例(69膝)半月板撕裂患者,均依据症状、专科检查、膝关节MRI及关节镜检查确诊。所有患者均在膝关节镜下行半月板撕裂部位新鲜化,然后在腰穿针辅助细钢丝引导下采用外-内-外法缝合半月板的撕裂部位。使用Lysholm评分、国际膝关节评分委员会(International Knee Documental Committee,IKDC)膝主观功能评分和疼痛视觉模拟量表(visual analogue scale,VAS)评分评估临床效果,膝关节MRI检查评估半月板愈合情况。结果所有患者手术顺利,术后均获随访,随访时间12~28个月,平均(13.20±3.51)个月,术前症状均消失,无血管神经损伤、感染、半月板再撕裂等并发症发生。MRI检查显示66膝半月板撕裂部完全愈合,愈合时间为4~14周,平均(7.83±1.25)周;3膝半月板撕裂部显示Ⅲ级信号,但患者无明显不适。术后6个月,膝关节Lysholm评分、IKDC评分明显高于术前,VAS评分明显低于术前,差异均有显著性(P<0.01)。术后6个月所有患者均可参加体育活动。结论膝关节镜下采用外-内-外法缝合半月板撕裂操作简单,可恢复半月板原有的形态及膝关节功能,短期效果好,值得临床应用。

Objective To investigate the clinical effect of outside-inside-out meniscus suture with lumbar trocar assisted and thin wire guided under knee arthroscope.Method From Oct 2014 to Oct 2021,66 patients(69 knees)were diagnosed as meniscal tears according to symptoms,special examinations,knee joint MRI and arthroscopy in Luoyang Orthopedic-Traumatological Hospital.The meniscal tear was freshened under knee arthroscopy,and then the meniscal tear was sutured with outside-inside-out method with lumbar trocar assisted and thin wire guided.The Lysholm knee function score,the IKDC subjective function score of knee joint and VAS pain score were used to evaluate the clinical efficacy after the surgery.Then menisci healing was examined by MRI.Result All patients operated were followed up regularly for 12 to 28 months,with an average of(13.20±3.51)months.The preoperative symptoms disappeared,and there was no vascular and nerve injury,infection,meniscus retear and other complications.The incision healed at grade A 2 weeks after surgery.At the first,third,sixth month and the last follow-up postoperation,the knee joint function was rechecked and the knee joint MR was performed respectively.66 cases of meniscal tears healed completely,the healing time was 4 to 14 weeks(mean 7.83±1.25)weeks;Three cases of meniscus tear showed grade III signal,but no discomfort.Six months after operation,the IKDC score,Lysholm score and VAS score of knee joint were significantly different from those before operation(P<0.01);It is available for sports activities after the sixth month.Conclusion Knee arthroscopic outside-inside-out meniscus suture with lumbar trocar assisted and thin wire guided is simple to operate which can maintain the meniscal original shape,stabilize the joints,maintain the line of force of the lower extremities,and eliminate the symptoms.The knee joint function recovers well after the operation,the short term result is good,therefore it is worthing to promote.