Pie-crusting松解膝关节内侧副韧带术后制动与否对其愈合的影响

Influence of Immobilization on Healing of Medial Collateral Ligament of Knee after the Medial Collateral Ligament Release by Pie-crusting

探讨用Pie-crusting技术松解内侧副韧带术后制动与否对内侧韧带愈合的影响。自2016年11月—2018年10月,膝关节镜手术中应用Pie-crusting技术(由外向内)松解内侧副韧带患者53例,其中病历号尾数为单数的患者(A组)术后给以膝关节可调支具固定制动;尾数为双数的患者(B组)术后未进行支具固定制动。术后6周做MRI(magnetic resonance imaging)检查两组病例膝关节内侧副韧带愈合情况;膝关节外翻应力X片测量膝关节内侧间隙;比较患者随访时的主观症状,评估Lysholm主观功能评分。平均随访时间为(28.75±4.028)个月(24~36个月)。术中通过松解内侧副韧带,两组病例均达到内侧理想操作空间,术后6周时组间比较术前术后膝关节内侧间隙无统计学意义(P>0.05);两组病例随访末次Lysholm功能评分均较术前提高,两组间无统计学意义(P>0.05);两组患者6周时MRI显示内侧副韧带均已愈合。应用关节镜处理膝关节内侧半月板损伤时,针对膝关节内侧间室狭窄的病例可选择Pie-crusting技术(由外向内)松解内侧副韧带,以其达到扩大操作空间,改善观察视野的目的,术后膝关节制动与否对内侧副韧带的愈合无影响。

To investigate the influence of pie-crusting technique on the healing of medial ligament after the release of collateral ligament.From November 2016 to October 2018,53 patients with medial collateral ligament were released by pie-crusting technique during arthroscopic knee surgery,patients whose medical record number ended in an odd number(group A)were given fixed immobilization with an adjustable knee brace after surgery;patients with even mantissa(group B)did not undergo brace immobilization after surgery.6 weeks after surgery,MRI(magnetic resonance imaging)was performed to examine the healing of medial collateral ligament of the knee in both groups:the medial space of the knee joint was measured by the stress X-ray of the knee joint space,the main gauge symptoms of the patients during follow-up were compared,and the Lysholm subjective function score was evaluated.The mean follow-up time of this study was(28.75±4.028)months(24~36 months).During the operation,the medial collateral ligament was released,and the ideal medial operation space was achieved in both groups.At 6 weeks after the operation,there was no statistical significance in the diurnal gap between the two groups before and after the operation(P>0.05).Lysholm function score at the last follow-up was higher in both groups than before,and there was no statistical significance between the two groups(P>0.05).MRI showed that the medial collateral ligament had healed in both groups at 6 weeks.When arthroscopy is applied to treat medial meniscus injury of knee joint,pie-crusting technique can be used to release medial collateral ligament for cases of intra-compartment stenosis of knee joint,so as to achieve the purpose of expanding operation space and improving observation field,and whether joint braking has no influence on the healing of medial collateral ligament.