腘肌腱裂孔前区缝合在外侧盘状半月板损伤并腘肌腱区不稳治疗中的应用

Application of anterior region suture of popliteal hiatus in treatment of discoid lateralmeniscus injury with instability in popliteal tendon region

目的 探讨关节镜下腘肌腱裂孔(popliteal hiatus,PH)前区缝合在外侧盘状半月板(discoid lateral meniscus,DLM)损伤并腘肌腱区不稳治疗中的应用。方法 回顾分析2014年3月—2022年11月收治且符合选择标准的53例(56膝)DLM损伤患者临床资料。男15例,女38例;年龄8~55岁,平均36.5岁。14例有外伤史,余39例无明确外伤史。病程1 d~6年,平均15.6个月。根据Watanabe分型:完全型40膝,不完全型16膝。术前国际膝关节文献委员会(IKDC)膝关节评分为(51.2±8.3)分,Lysholm评分为(59.6±11.2)分,疼痛视觉模拟评分(VAS)为(4.7±1.3)分。行关节镜下半月板成形术后,用探钩牵拉检查腘肌腱区半月板均存在不稳,进而采用Out-inside技术或Out-inside技术联合All-inside技术缝合PH前区,检查缝合后半月板稳定性,必要时再采用All-inside技术缝合PH后区、半月板后角和Out-inside技术缝合半月板前角。记录并发症发生情况;采用手术前后IKDC评分、Lysholm评分和VAS评分评价疗效。结果 术后膝关节疼痛、关节弹响及交锁症状消失,McMurray试验及研磨试验转为阴性。53例患者均获随访,随访时间12~93个月,平均57.5个月。无腓总神经损伤、下肢深静脉血栓形成、关节感染和关节僵硬等并发症发生。末次随访时IKDC膝关节评分为(76.7±5.5)分,Lysholm评分为(94.0±4.1)分,VAS评分为(1.1±0.8)分,与术前比较差异均有统计学意义(t=-22.090,P<0.001;t=-23.704,P<0.001;t=19.767,P<0.001)。结论 PH前区缝合是DLM损伤并腘肌腱区不稳治疗的关键。

Objective To discuss the application of anterior region suture of the popliteal hiatus(PH)under arthroscopy in the treatment of discoid lateral meniscus(DLM)injury with instability in the popliteal tendon region.Methods The clinical data of 53 patients(56 knees)with DLM injury who met the selection criteria between March 2014 and November 2022 were retrospectively analyzed.There were 15 males and 38 females,aged 8-55 years with an average age of 36.5 years.Fourteen cases had a history of trauma,while the remaining 39 cases had no clear history of trauma.The disease duration ranged from 1 day to 6 years,with an average duration of 15.6 months.According to the Watanabe classification,there were 40 knees of complete type and 16 knees of incomplete type.The preoperative International Knee Documentation Committee(IKDC)knee joint score was 51.2±8.3,the Lysholm score was 59.6±11.2,and the visual analogue scale(VAS)score was 4.7±1.3.After the arthroscopic meniscal plasty,the instability of the popliteal tendon region meniscus was checked by probing traction.Subsequently,the Out-inside technique or a combination of Out-inside and All-inside techniques was used to suture the anterior region of the PH.The stability of the meniscus after suturing was assessed,and if necessary,further suturing using the All-inside technique at the posterior region of the PH,the posterior horn of the meniscus,and using the Out-inside technique at the anterior horn of the meniscus was performed.Postoperative complications were recorded. The effectiveness was evaluated using pre- and post-operative IKDC scores,Lysholm scores, and VAS scores. Results After operation, knee joint pain, crepitus, and locking disappeared, withMcMurray and grinding tests turning negative. All patients were followed up 12-93 months with an average of 57.5months. There was no complication such as common peroneal nerve injury, deep vein thrombosis of the lower limbs, jointinfection, or joint stiffness. At last follow-up, the IKDC knee joint score was 76.7±5.5, the Lysholm score was 94.0±4.1, andthe VAS score was 1.1±0.8. The differences compared with preoperative scores were significant (t=−22.090, P<0.001;t=−23.704, P<0.001;t=19.767, P<0.001). Conclusion Suturing of the anterior region of the PH is crucial in the treatmentof DLM injury with instability in the popliteal tendon region.