关节镜下同种异体半月板移植的疗效分析  

The clinical results of arthroscopic transplantation of meniscal allograft and second-look arthroscopy

作　　者：章亚东[1] 侯树勋[1] 张轶超[1] 罗殿中[1] 衷鸿宾[1] 史亚民[1] 吴闻文[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中华骨科杂志》2010年第2期175-181,共7页Chinese Journal of Orthopaedics

基　　金：北京首都医学发展基金项目（20073044）;全军十一五科研计划项目（08ZL084）

摘　　要：目的探讨关节镜下同种异体半月板移植微创手术的临床疗效。方法2006年1月至2008年7月，对21例（22侧）半月板损伤后切除半月板的患者行关节镜下同种异体半月板移植手术。在关节镜下用膝关节定位器制作容纳半月板前、后角骨栓（骨桥）的骨道（骨槽），将大小匹配的带有前、后角骨栓（骨桥）的同种异体半月板植入适当位置，并与关节囊缝合固定。全部患者于术前行MR检查，13例于术后1年复查MR。采用VAS疼痛评分、Lysholm评分和IKDC分级方法评价膝关节功能。3例分别于术后3、9及18个月行二次天节镜探查。结果全部病例无手术副损伤、感染或需摘除移植半月板者。随访6-28个月，平均16_3个月。患者手术前后膝关节均可伸直，屈曲活动度差异无统计学意义。VAS疼痛评分术前（7．0±2．3）分、术后（3．2±1．3）分，Lysholm评分术前（64.3±15．7）分、术后（80．1±19．4）分，差异均有统计学意义。术后IKDC分级较术前明显改善。术后3个月关节镜检查示移植半月板与关节囊基本愈合，形态完整；术后9个月移植半月板质地偏硬；术后18个月移植半月板与关节囊愈合牢固，质地接近正常半月板。术前与术后关节软骨分级差异无统计学意义。结论同种异体半月板移植早期临床效果满意，移植半月板与周围组织愈合良好。但术后早期稳定性稍差，容易损伤。Objective To investigate the clinical results of arthroscopic meniscal allograft trans- plantation, Methods The meniscal allograft transplantation were performed with arthroscopie technique on 21 patients carried out meniscectomy after meniscus injury from January 2006 to July 2008. A proper size meniscal allograft with bone plugs or bridge attached on anterior and posterior comer of the meniscus was implanted, which was sutured with the capsule. MR examination were performed for all of the patients before operation and 13 patients one year after operation. The VAS, Lysholm score and IKDC were recorded before and after operation. 3 cases were performed arthroseopy again at the 3rd, 9th and 18th month respectively after operation. Results The clinical results were investigated from 6 to 28 months （average 16.3 months） after operations. There was not any side-injury, infection and meniscus removed after operations. The VAS after operation （3.2±1.3） was significant lower than that of preoperation （7.0±2.3）. There was significantly different in Lysholm score between preoperation （64.3±15.7） and postoperation （80.1±19.4）. Using the IKDC activity rating system, the rate of normal or nearly normal before operations （14.3%） was lower than that after operations （76.2%, P〈 0.05）. The second-look arthroscopy showed that the initial healing occurring between meniscal allograft and the capsule and meniscal allograft was normal shape at the 3rd month, with less elasticity, relative rigidity at the 9th month, and similar to the normal meniscus at the 18th month postoperatively. There was no significant difference in the MRI degree of joint cartilage pre- and post- operation. Conclusion A good short-term clinical result could be observed after meniscal allograft. But the meniscal allograft may be relative instability, fragile and easy injured.

关 键 词：半月板 胫骨 移植 同种 关节镜检查 外科手术 微创性 

分 类 号：R687.4[医药卫生—骨科学]