关节镜下可吸收性半月板箭治疗半月板损伤的初步报告

Biodegradable meniscus arrows for arthroscopic repair of meniscal tears

目的关节镜下应用可吸收性半月板箭治疗半月板损伤并评价其近期疗效。方法2002年2～10月,关节镜下采用半月板箭缝合固定12例12侧半月板损伤,男5例,女7例;年龄18～58岁,平均33.2岁。左膝4例,右膝8例。内侧半月板损伤4例,外侧半月板损伤8例;前角损伤2例,体部损伤3例,后角损伤7例。红区损伤10例,红-白区损伤2例。病程3d～5个月,平均2.3个月,其中急性损伤(病程<1个月)9例。关节镜下采用新型全内半月板箭技术固定,共使用25枚半月板箭(平均每例2.1枚)。5例同时施行其它类型手术。结果所有病例术后均无早期并发症发生。全部患者均获得随访,随访时间7～13个月,平均10.2个月。随访时所有患者膝关节稳定,无疼痛、绞锁等症状,6周后关节活动度全面恢复。Lysholm评分由术前的平均(45.6±13.4)分增加到术后平均(82.4±16.3)分,差异有显著性(P< 0.05)。2例分别于术后8个月和9个月出现关节积液,考虑为滑膜炎,经治疗后消失。结论对于半月板损伤,如撕裂类型和部位适当,可选择可吸收性半月板箭治疗。半月板箭技术是一种简便快捷、安全有效的半月板缝合方法。

Objective To assess the short-term clinical outcomes of biodegradable meniscus arrows to repair meniscal injury arthroscopically. Methods From February to October 2002, meniscal tears in 12 patients were repaired using biodegradable meniscus arrows under arthroscopy. There were 5 males and 7 females, and the age was ranging from 18 to 58 years with a mean of 33.2 years. The right knee joint was affected in 8 and left in 4, and 5 of the knee joints were associated with anterior or posterior cruciate ligament injury treated simultaneously. The interval from injury to index surgery ranged from 3 days to 5 months with an average of 2.3 months, and 9 meniscuses were acute tears(less than 1 month). There were tears in 4 medial meniscuses and 8 in lateral meniscuses, among which anterior horn injury was in 2, body injury in 3, and posterior horn injury in 7. All the injuries were classified as longitudinal tear except 1 of complex tear. 10 tears were located at red zone, and 2 at red-white zone. The tears were fixed arthroscopically using all-inside technique with biodegradable meniscus arrows. A total of 25 arrows(average 2.1 arrows per meniscal tear) were used. Results There were no any signs of complications after operations in the patients. All cases were reviewed and followed-up postoperatively ranging from 7 to 13 months (mean, 10.2 months). The knee joints in all patients were clinically stable and asymptomatic at final follow-up. According to Lysholm scoring scale system, the average score of the operated knees was increased from preoperative 45.6±13.4 to postoperative 82.4±16.3 points, and the difference was of statistical significance(P<0.05). Effusion and synovitis developed in 2 cases respectively after 8 and 9 months of the surgery, and disappeared after aspiration of joint and usage of the NSAIDs. Conclusion The use of meniscus arrows is a simple, safe and reliable method for repair of properly selected meniscal tears.