膝内侧副韧带拉花松解技术在内侧间室狭窄半月板损伤关节镜手术中的应用

Application of the Pull-flower Release Technique of the Medial Collateral Ligament of the Knee in Arthroscopic Surgery for Meniscal Injuries with Medial Compartment Stenosis

目的分析膝内侧副韧带拉花松解技术在内侧间室狭窄半月板损伤关节镜手术中的应用。方法选取于2022年12月至2024年2月在临川区第一人民医院收治的76例半月板损伤合并内侧间室狭窄的患者作为研究对象,依据随机数字表法分为对照组(n=38)与观察组(n=38)。在关节镜手术中,对照组采取骨膜下松解术治疗,观察组进行膝内侧副韧带拉花松解技术治疗。对比两组患者松解前后的内侧间隙、手术完成情况(医源性损伤)、手术时间、术后不良反应(内侧副韧带疼痛、皮下瘀斑)、外翻应力、膝关节主观功能评分、膝部疼痛视觉模拟量表(VAS)、损伤愈合情况。结果76例半月板损伤合并内侧间室狭窄的患者均在充分的视野显露下完成手术,没有出现医源性骨软骨损伤、神经血管损伤、内侧副韧带撕裂等并发症。治疗后的内侧间隙、IKDC评分均高于治疗前,VAS评分低于治疗前;观察组的内侧间隙、IKDC评分高于对照组,VAS评分低于对照组(P<0.05)。观察组术后总不良率(7.89%)明显低于对照组术后总不良率(26.32%)(P<0.05)。两组患者术前外翻应力试验均为阴性,观察组术后第1天8例Ⅰ度阳性,术后4周2例Ⅰ度阳性;对照组术后第1天14例Ⅰ度阳性,术后4周4例Ⅰ度阳性,术后12周两组患者均转为阴性。术后3个月,观察组半月板损伤愈合有29例,对照组有20例;术后6个月,观察组半月板损伤愈合有35例,对照组有28例,差异均具有统计学意义(P<0.05)。结论治疗内侧间室狭窄合并半月板损伤的患者在使用关节镜手术时,采取膝内侧副韧带拉花松解技术可以明显增大膝关节内侧间隙来改善手术视野范围,减轻膝关节引起的疼痛,促进其功能恢复。

Objective To analyze the application of pulling flower release technique of medial collateral ligament of the knee in arthroscopic surgery for medial interstitial stenosis meniscus injury.Methods Seventy-six patients with meniscus injury combined with medial interstitial stenosis admitted to the First People's Hospital of Linchuan District from December 2022 to February 2024 were selected as the study subjects,and were divided into the control group(n=38)and the observation group(n=38)based on the method of randomized numerical table.In arthroscopic surgery,the control group was treated with subperiosteal release,and the observation group was treated with the pulling flower release technique of the medial collateral knee ligament.The medial gap,surgical completion(medical injury),surgical time,postoperative adverse effects(medial collateral ligament pain,subcutaneous ecchymosis),valgus stress,subjective knee function score,visual analog scale(VAS)of knee pain,and injury healing were compared between the two groups before and after the release.Results Seventy-six patients with meniscus injuries combined with medial compartment stenosis were operated under adequate visual field visualization,and there were no complications such as medically induced osteochondral injuries,neurovascular injuries,or medial collateral ligament tears.The medial interspace and IKDC scores after treatment were higher than those before treatment,and the VAS scores were lower than those before treatment;in the observation group,the medial interspace and IKDC scores were higher than those in the control group,and the VAS scores were lower than those in the control group(P<0.05).The total postoperative malpractice rate in the observation group(7.89%)was significantly lower than the total postoperative malpractice rate in the control group(26.32%)(P<0.05).The preoperative external rotation stress test was negative in both groups,8 cases ofⅠdegree positive in the observation group on the 1st day after operation,and 2 cases ofⅠdegree positive in the observation group at 4 weeks after operation;14 cases ofⅠdegree positive in the control group on the 1st day after operation,4 cases ofⅠdegree positive in the control group at 4 weeks after operation,and the patients of both groups turned to be negative at 12 weeks after operation.At 3 months after operation,29 cases of meniscus injury healed in the observation group and 20 cases in the control group;at 6 months after operation,35 cases of meniscus injury healed in the observation group and 28 cases in the control group,and the differences were statistically significant(P<0.05).Conclusion In treating patients with medial compartment stenosis combined with meniscus injuries,when using arthroscopic surgery,adopting the technique of pulling flower release of the medial collateral ligament of the knee can significantly increase the medial gap of the knee joint to improve the range of surgical field of vision,reduce the pain caused by the knee joint,and promote the recovery of its function.