股骨和胫骨隧道技术联合U形缝合治疗内侧半月板后根撕裂伴后交叉韧带断裂效果分析

Effect analysis of femoral and tibial tunnel technique combined with U-shape suture in treatment of posterior root tear of medial meniscus with posterior cruciate ligament rupture

目的探讨股骨和胫骨隧道技术联合U形缝合治疗内侧半月板后根撕裂伴后交叉韧带断裂的效果和安全性。方法回顾性分析广州市番禺区中医院骨伤科2020-01—2022-01收治的50例半月板后根撕裂并后交叉韧带断裂患者的临床资料。依据治疗方法分为2组,每组25例。对照组应用关节镜下半月板内-外缝合及后交叉韧带B-T-B修复技术,观察组采用股骨、胫骨隧道技术联合U形缝合术。比较2组手术相关指标。术前、术后4周时依据日常生活活动能力(ADL)量表评估患者的自理能力、依据Lysholm膝关节评分和美国膝关节协会评分(AKS)评价患者的膝关节功能。术后4周、术后4个月时通过反向轴移试验、后抽屉试验及研磨试验评价膝关节稳定性。统计随访期间并发症发生率及半月板愈合率。结果观察组的手术时间、术后48 h的NRS评分、术后首次负重行走时间均短于对照组,术后4周时的ADL、Lysholm、AKS评分均优于对照组,差异有统计学意义(P<0.05)。术后4个月时2组反向轴移试验、后抽屉试验及研磨试验阳性率均显著低于术后4周时,差异有统计学意义(P<0.05),2组间的首次下床时间差异无统计学意义(P>0.05)。随访期间2组并发症发生率及半月板愈合率的差异无统计学意义(P>0.05)。结论内侧半月板后根撕裂并后交叉韧带撕裂患者应用股骨和胫骨隧道技术联合U形缝合是安全、可行的,既能保障修复效果,又能减少手术损伤、缩短手术时间、缓解术后疼痛,更利于膝关节功能康复。

Objective To investigate the efficacy and safety of femoral and tibial tunnel technique combined with U-suture in the treatment of posterior root tear of medial meniscus with posterior cruciate ligament rupture.Methods Totally 50 patients with meniscus posterior root tear and posterior cruciate ligament rupture admitted to our hospital from January 2020 to January 2022 were divided into two groups.The control group was treated with arthroscopic meniscus medial and external suture and posterior cruciate ligament B-T-B repair technology,and the observation group was treated with femoral and tibial tunnel technology+U-shaped suture.The operation related indicators and healing rate were compared.Preoperative and postoperative evaluation of knee joint function,and before the surgery,4 weeks after surgery and postoperative knee stability assessment when 4 months;The degree of limb pain was evaluated before operation and 48 hours after operation.The changes of self-care ability were compared before operation and at the end of follow-up,and the incidence of complications was counted.Results observation group operation time,postoperative weight-bearing walking time for the first time are shorter than that of the control group,and postoperative Lysholm knee score,the knee society score(AKS)were higher than that of the control group(P<0.05);At 4 months after surgery,the positive rate of reverse axis shift test,posterior drawer test and grinding test were significantly lower than at 4 weeks after surgery,and the difference was statistically significant(P<0.05),but the difference between the 2 groups was not significant(P>0.05),The numerical rating scale(NRS)score of the observation group was significantly lower than that of the control group,and the score of activities of daily living(ADL)was higher than that of the control group.Compared of complicationsthe two groups have no difference(P>0.05).Conclusion Femur and tibial tunnel combined with U-shape suture is feasible for patients with medial meniscus posterior root tear and posterior cruciate ligament tear,which can not only guarantee the repair effect,but also reduce the surgical injury,shorten the operation time,relieve postoperative pain,and more conducive to the functional rehabilitation of knee joint.