自体腓骨长肌腱重建半月板的短期临床疗效  

Short-erm clinical outcomes of meniscal reconstruction with autologous peroneus longus tendon

作　　者：弓爵 李瑞欣 魏志亨 贾梦阳 王卫明 向先祥 Gong Jue;Li Ruixin;Wei Zhiheng;Jia Mengyang;Wang Weiming;Xiang Xianxiang(Department of Sports Medicine,Affiliated Xinhua Hospital of Dalian University,Dalian 116021,China)

机构地区：[1]大连大学附属新华医院运动医学科,大连116021

出　　处：《中华骨科杂志》2024年第20期1349-1357,共9页Chinese Journal of Orthopaedics

基　　金：大连市医学科学研究计划(2311038)。

摘　　要：目的探讨自体腓骨长肌腱重建半月板的短期临床疗效。方法回顾性分析2020年6月至2022年6月于大连大学附属新华医院采用自体腓骨长肌腱重建半月板的患者20例,男12例、女8例,年龄(37.8±5.7)岁(范围31~47岁),体质指数(26.3±5.8)kg/m 2(范围20.1~31.3 kg/m 2)。依据年龄、体质指数和随访时间匹配行半月板部分切除术患者20例,男15例、女5例,年龄(39.1±6.2)岁(范围32~47岁),体质指数(25.6±5.4)kg/m 2(范围20.2~32.7 kg/m 2)。记录术前及术后3、6、12、24个月国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分、Lysholm评分、疼痛视觉模拟评分(visual analogue scale,VAS)、膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS),评估移植物的形态和信号强度、软骨损伤Recht分级及二次关节镜检情况。结果肌腱移植组随访时间为(24.3±4.3)个月,半月板部分切除组为(24.2±3.6)个月。术后3、6个月,半月板部分切除组较肌腱移植组有更高的膝关节功能评分(P<0.05);术后3个月半月板部分切除组VAS评分小于肌腱移植组(P<0.05),而术后6个月两组差异无统计学意义(P>0.05)。术后12个月两组患者的疼痛及功能评分的差异均无统计学意义(P>0.05)。术后24个月,肌腱移植组的Lysholm评分[(84.31±12.20)分]、IKDC评分[(82.21±10.55)分]、VAS[(2.10±1.74)分]及KOOS[(85.37±13.14)分]均优于半月板部分切除组的(72.67±14.18)、(74.09±11.68)、(3.80±1.81)、(75.14±17.94)分,差异均有统计学意义(P<0.05)。肌腱移植组术后24个月时移植物-残余半月板复合体为3级的患者19例,较术后3个月(5例)有明显改善;术后3个月时无一例移植物信号强度为3级,而至术后24个月时改善为19例。术后24个月,MRI示肌腱移植组和半月板部分切除组发生软骨损伤的患者分别为7例和20例,出现严重软骨损伤(Recht分级>Ⅱ级)的患者分别为1例和7例。肌腱移植组以术后ObjectiveTo evaluate the short-term clinical outcomes of meniscus reconstruction using autologous peroneus longus tendon grafts.MethodsA retrospective analysis was conducted on 20 patients(12 males,8 females)with a mean age of 37.8±5.7 years(range,31-47 years)and a mean body mass index(BMI)of 26.3±5.8 kg/m 2(range,20.1-31.3 kg/m 2)who underwent meniscal reconstruction with autologous peroneus longus tendon in Affiliated Xinhua Hospital of Dalian University from June 2020 to June 2022.A control group of 20 patients(15 males,5 females),with a mean age of 39.1±6.2 years(range,32-47 years)and a mean BMI of 25.6±5.4 kg/m 2(range,20.2-32.7 kg/m 2),underwent partial meniscectomy during the same period.Clinical outcomes were assessed using the International Knee Documentation Committee(IKDC)score,Lysholm score,visual analogue scale(VAS)for pain,and the Knee Injury and Osteoarthritis Outcome Score(KOOS)at 3,6,12,and 24 months postoperatively.The morphology and signal intensity of grafts,Recht grading for cartilage damage,and the need for secondary arthroscopy were also evaluated.ResultsThe mean follow-up duration was 24.3±4.3 months for the tendon graft group and 24.2±3.6 months for the partial meniscectomy group.At 3 and 6 months postoperatively,the partial meniscectomy group demonstrated superior knee function scores compared to the tendon graft group(P<0.05).Similarly,VAS were lower in the partial meniscectomy group at 3 months postoperatively(P<0.05),although no significant difference was found at 6 months(P>0.05).By 12 months postoperatively,differences in pain and function between the two groups were no longer statistically significant(P>0.05).At 24 months,the tendon graft group exhibited significantly better outcomes in terms of the Lysholm score(84.31±12.20 vs.72.67±14.18),IKDC score(82.21±10.55 vs.74.09±11.68),VAS score(2.10±1.74 vs.3.80±1.81),and KOOS score(85.37±13.14 vs.75.14±17.94)compared to the partial meniscectomy group(P<0.05).Regarding graft healing,19 patients in the tendon graft group dem

关 键 词：腱 半月板 移植 自体 

分 类 号：R687.2[医药卫生—骨科学]