“环抱”缝合法修复内侧半月板桶柄状撕裂中期疗效观察  

Medium-term clinical outcome of encircled suture for repair of medial meniscus bucket-handle tear

作　　者：吴冰[1] 陆伟[1] 王大平[1] 柳海峰[1] 朱伟民[1] 欧阳侃[1] 李皓[1] 

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)运动医学科,广东深圳518000

出　　处：《中国修复重建外科杂志》2017年第3期278-283,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省科技计划项目(2014A020212656;2014A030401017);深圳市卫生计生系统科研项目(201506025);深圳市科技研发计划项目(JCYJ20140414170821213;JCYJ20140414170821157)~~

摘　　要：目的探讨"环抱"缝合法修复内侧半月板桶柄状撕裂(bucket-handle tear,BHT)的中期疗效。方法总结2011年3月—2013年6月采用关节镜下"环抱"缝合法修复内侧半月板BHT的78例(78膝)患者临床资料。男57例,女21例;年龄16~39岁,平均28.3岁。致伤原因:运动损伤61例,交通事故伤12例,其他伤5例。新鲜损伤35例,陈旧性损伤43例。合并前交叉韧带损伤65例。术前国际膝关节文献委员会(IKDC)评分、Lysholm评分、Tegner评分分别为(48.2±6.3)、(43.6±4.7)、(2.5±0.6)分。MRI检查示半月板Ⅲ度撕裂。术后采用Barrett等的评价标准、MRI检查、二次关节镜检查评估半月板愈合情况,并采用IKDC评分、Lysholm评分和Tegner评分评价膝关节功能。结果术后切口均Ⅰ期愈合,无关节感染、异物排斥等并发症发生。患者均获随访,随访时间26~63个月,平均42.8个月。2例术后1年内BHT复发。末次随访时,根据Barrett等的标准,72例半月板达临床愈合,临床愈合率为92.3%。IKDC评分、Lysholm评分、Tegner评分分别为(81.5±5.1)、(86.9±3.9)、(6.2±0.5)分,与术前比较差异均有统计学意义(t=–14.598,P=0.000;t=–18.478,P=0.000;t=–3.362,P=0.002)。MRI复查示,末次随访时56例半月板完全愈合,15例部分愈合,7例全层面不愈合,总愈合率为91.0%(71/78)、完全愈合率为71.8%(56/78)。21例于术后18~49个月行二次关节镜探查,其中17例半月板达完全愈合,4例为部分愈合,总愈合率为100%(21/21)、完全愈合率为81.0%(17/21);均无新撕裂出现。结论采用关节镜下"环抱"缝合法修复内侧半月板BHT,具有缝合牢固、对半月板血供影响小的特点,可取得满意的中期疗效。Objective To investigate the medium-term clinical outcome of encircled suture for repair of medial meniscus bucket-handle tear （BHT）. Methods Between March 2011 and June 2013, 78 patients （78 knees） with medial meniscus BHT were treated with encircled suture under arthroscopy. There were 57 males and 21 females with a mean age of 28.3 years （range, 16-39 years）. The causes included sports injury in 61 cases, traffic accident injury in 12 cases, and other trauma in 5 cases. Of 78 cases, 35 were acute injury and 43 were chronic injury; 65 cases had combined injury of anterior cruciate ligament rupture. International Knee Documentation Committee （IKDC） score, Lysholm score, and Tegner score were 48.2±6.3, 43.6±4.7, and 2.5±0.6, respectively. Barrett＇s assessment standard, MRI, and arthroscopy examination were used for assessment of meniscus healing. IKDC score, Lysholm score, and Tegner score were used for assessment of knee function. Results Primary healing of incisions were achieved in all patients, and no complications occurred. All patients were followed up 26-63 months （mean, 42.8 months）. BHT recurrence was observedin 2 patients within 1 year. Clinical healing of meniscus tear was obtained in 72 cases （92.3%） according to Barrett＇s assessment standard. The IKDC score, Lysholm score, and Tegner score were significantly improved to 81.5±5.1, 86.9±3.9, and 6.2±0.5 respectively （t=-14.598, P=0.000; t=-18.478, P=0.000; t=-3.362, P=0.002）. MRI results showed complete healing in 56 cases, incomplete healing in 15 cases, and unhealing in 7 cases at last follow-up, with a total healing rate of 91.0% （71/78） and a complete healing rate of 71.8% （56/78）. In 21 cases undergoing arthroscopy at 18-49 months after operation, complete healing and incomplete healing were observed in 17 cases and 4 cases respectively, with a total healing rate of 100% （21/21） and a complete healing rate of 81.0% （17/21）. No re-tear occurred. Conclusion Encircled suture for repair of medial m

关 键 词：内侧半月板 桶柄状撕裂 “环抱”缝合法 关节镜 

分 类 号：R687.4[医药卫生—骨科学]