半月板成形和缝合治疗累及腘肌腱裂孔的盘状软骨损伤  

MENISCAL PLASTY AND SUTURE REPAIR FOR TORN DISCOID LATERAL MENISCUS INVOLVING POPLITEAL HIATUS

作　　者：戴祝[1] 陈疾忤[2] 陈世益[2] 陈志伟[1] 范伟杰[1] 廖瑛[1] 蒋佳[2] 

机构地区：[1]南华大学附属第一医院骨外科,湖南衡阳421001 [2]复旦大学运动医学中心复旦大学附属华山医院运动医学及关节镜外科

出　　处：《中国修复重建外科杂志》2011年第1期13-16,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结关节镜下半月板成形和腘肌腱裂孔前、后缝合治疗累及腘肌腱裂孔的外侧盘状软骨损伤临床疗效。方法 2008年1月-2009年5月,收治21例累及腘肌腱裂孔的外侧盘状软骨损伤患者。男9例,女12例;年龄12～45岁,平均22.5岁。左膝12例,右膝9例。7例既往有外伤史,14例无明确外伤史。病程3个月～2年,平均6.4个月。患者术前均有膝关节疼痛或交锁,McMurray试验及碾磨试验均呈阳性。根据Watanabe分型:完全型17例,不完全型4例;损伤均累及腘肌腱裂孔。关节镜下行半月板成形,进而采用由外向内缝合腘肌腱裂孔前方,FasT-Fix半月板修复系统全内缝合腘肌腱裂孔后方。结果患者术后切口均Ⅰ期愈合,无关节感染、关节僵硬、腓总神经损伤等并发症发生。21例均获随访,随访时间12～28个月,平均18个月。术后关节交锁及疼痛症状均消失,McMurray试验及碾磨试验均呈阴性。膝关节功能Lysholm评分由术前(54.0±13.4)分提高至术后12个月的(90.0±6.6)分,差异有统计学意义(t=—12.00,P=0.00)。参考Cameron等改良的Lysholm评分分级标准,获优14例,良5例,可2例,优良率90.5%。结论 对于累及腘肌腱裂孔的盘状软骨损伤,在半月板成形的基础上,缝合固定腘肌腱裂孔处前、后结构,能最大程度保留外侧半月板周缘并保持其稳定性。Objective To observe the outcome of arthroscopic meniscal plasty and suture repair to treat torn discoid lateral meniscus involving popliteal hiatus.Methods Between January 2008 and May 2009,21 cases of torn discoid lateral meniscus involving popliteal hiatus were treated by arthroscopic surgery.There were 9 males and 12 females with an average age of 22.5 years（range,12-45 years）,including 12 left knees and 9 right knees.Seven cases had the history of injury and other 14 cases had uncertain trauma.The average disease duration was 6.4 months（range,3 months to 2 years）.All patients complained knee pain or locking with positive McMurray test and milling test before surgery.All cases had torn discoid lateral meniscus,and the tear extended to the popliteal hiatus,including 17 cases of complete type and 4 cases of incomplete type according to the Watanabe classification.After meniscal plasty,suture repair of torn popliteal lateral hiatus was performed.The anterior part to hiatus was repaired by the outside-in technique,and the posterior part underwent repair of all inside technique by FasT-Fix.Results All wounds healed by first intention with no complications such as infection,stiffness of knee,or injury of common peroneal nerve.All patients were followed up 12-28 months with an average of 18 months.The symptoms of knee pain or locking disappeared postoperatively with negative McMurray test and milling test in all patients.The Lysholm score was improved from 54.0 ± 13.4 to 90.0 ± 6.6 at 12 months postoperatively,showing significant difference（t=— 12.00,P=0.00）.Based on the improved Lysholm classification standard,the results were excellent in 14 cases,good in 5,and fair in 2;the excellent and good rate was 90.5%.Conclusion For torn discoid lateral meniscus involving popliteal hiatus,based on meniscal plasty,suture repair of the popliteal hiatus would contribute to preserve the peripheral part and restore its stability.

关 键 词：关节镜 盘状软骨损伤 腘肌腱裂孔 半月板成形术 半月板缝合术 

分 类 号：R687.3[医药卫生—骨科学]