半月板移植的早期临床疗效分析  

Analysis of preliminary clinical results of meniscal allograft transplantation

作　　者：冯华[1] 张辉[1] 洪雷[1] 耿向苏[1] 王雪松[1] 张晋[1] 刘心[1] 

机构地区：[1]北京积水潭医院运动损伤科北京大学第四临床医院,100035

出　　处：《中华骨科杂志》2010年第4期351-356,共6页Chinese Journal of Orthopaedics

摘　　要：目的报告一组同种异体半月板移植病例的早期临床疗效。方法2006年6月至2008年7月连续完成19例手术，18例入选本组。年龄21-52岁，平均38岁；男9例，女9例；外侧半月板11例，内侧7例。其中合并前十字韧带损伤7例，合并多发韧带损伤2例，合并胫骨平台骨折1例。适应证为半月板缺损，关节软骨Ⅲ度以下或局限性Ⅳ度损伤，关节力线正常，韧带正常，韧带同期或分期重建者。手术技术：2例外侧半月板采用骨桥技术，16例采用骨栓技术。采用四种技术缝合移植物的周边部分。韧带受损者同期或分期进行重建手术和半月板移植手术。结果所有患者均得到16-41个月的随访，平均26个月。18例手术探查结果显示移植半月板完整或基本完整者16例（89％），失效2例（11％，行切除术）。有1例患者出现术后关节粘连，行关节镜下松解手术。1例术后1年出现半月板囊肿。18例中的15例接受厂主观评估，Lysholm评分由术前的平均67分（62-77分）增加至术后的85分（72-100分），IKDC评分由术前的B级6例、C级9例，改善至术后的A级2例，B级12例，C级1例。VAS疼痛评分由术前的平均6．2分（5-7分）减少到术后的2．1分（0-4分）（满分10分）。结论本组18例关节镜下同种半月板移植手术的早期临床主、客观结果满意，术后1-3年的存活率89％。Objective The purpose of this study was to report the preliminary outcomes of a series of patients who had undergone allografl meniscus transplantation with a minimum 1-year follow-up. Methods From June 2006 to July 2008,19 consecutive patients underwent meniscus allograft transplantation. Of them, 18 cases were included in this study. There were nine males and nine females. The patients ranged from twenty-one to fifty-two years old, with an average age of 38 years.The injury of anterior cruciate ligament was found in 7patients. There were multiple injury of ligaments of knee and fracture of tibial plateau in 2 patients and one patient. Surgical technique：16 menisci were transplanted using the double bone plug technique, 2 lateral menisci wers fixed using the bone bridge technique. Variable meniscus repair techniques were used for suturing the graft menisci＇s rim to capsule.The injury of ligament could be repaired stably by a concomitant reconstructive procedure at the time of transplantation or a separate surgery. Results Eighteen patients were followed up. The follow-up time ranged from 16 to 41 months,with the mean of 26 months. The allogrates were assessed by second-look arthroscopy. It comfirmed that 16 cases were normal or nearly normal and two （11%）failed which solved with meniscectomy. Postoperative stiff knee occured in one patient who required arthroscopic arthrolysis. One patient with meniscal cyst underwent conservative treatment. 15 patients were assessed by full subjective evaluation. The mean Lysholm scores had improved from 67 to 85. On IKDC evaluation, two patients were grade A and twelve were grade B, one were grade C. With regard to pain and satisfaction, the average VAS had improved from 6.2 to 2.1. Conclusion Arthrosocpic meniscus transplantation can achieve satisfied subjective and objective clinical outcomes with 89% survival rate over a mean follow-up period of 26 months .

关 键 词：半月板 胫骨 移植 同种 内窥镜检查 

分 类 号：R687.4[医药卫生—骨科学]