中国修复重建外科杂志

中国修复重建外科杂志

关节镜下一期治疗前交叉韧带损伤合并半月板桶柄样撕裂的疗效观察

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目的 探讨关节镜下前交叉韧带(anterior cruciate ligament,ACL)重建联合半月板缝合修补术治疗 ACL 损伤合并半月板桶柄样撕裂(bucket-handle tear,BHT)的临床疗效。 方法 将 2013 年 1 月—2014 年 4 月收治并符合选择标准的 22 例(22 膝)ACL 损伤合并半月板 BHT 患者纳入研究。其中,男 14 例,女 8 例;年龄 15~44 岁,平均 30.68 岁。左膝 10 例,右膝 12 例。内侧半月板损伤 14 例,外侧 8 例。初次受伤至入院时间为 9 h~4 年,中位时间 40 d。于关节镜下首先行半月板缝合修补术,然后行 ACL 单束重建。 结果 术后患者切口均Ⅰ期愈合,均未出现感染、血管神经损伤等严重并发症。22 例患者均获随访,随访时间 12~42 个月,平均 26.7 个月。1 例术后 6 周关节功能活动仍受限,经麻醉下手法松解后功能恢复良好;1 例存在关节间隙压痛,经保守治疗后疼痛缓解。临床有效率为 90.9%(20/22)。末次随访时,患者前抽屉试验、Lachman 试验、McMurray 试验均为阴性。术后 12 个月疼痛视觉模拟评分(VAS)、Tegner 运动水平评分、Lysholm 评分均较术前显著改善,比较差异有统计学意义(P<0.05)。术后 6~12 个月行 MRI 复查,参考 Crues 等的 MRI 评估标准,7 例完全愈合,11 例部分愈合,4 例不愈合。随访期间均无 ACL 再断裂发生。 结论 关节镜下半月板缝合修补联合 ACL 单束重建治疗 ACL 损伤合并 BHT,能有效缓解临床症状、降低半月板再次撕裂概率,延缓关节软骨退行性变,维持膝关节稳定性。

Objective To explore the clinical efficacy of arthroscopic simultaneous both anterior cruciate ligament (ACL) reconstruction and suture of the meniscus bucket-handle tear (BHT). Methods Between January 2013 and April 2014, 22 patients (22 knees) with ACL injury and BHT, who accorded with the inclusion criteria, were studied. There were 14 males and 8 females with a mean age of 30.68 years (range, 15-44 years). The left side was involved in 10 cases and the right side in 12 cases. Injury located at the medial meniscus in 14 patients, and at the lateral meniscus in 8 patients. The median of interval from injury to operation was 40 days (range, 9 hours to 4 years). BHT was sutured, and then single bundle reconstruction of ACL was performed under arthroscopy. Results All incisions healed by first intention, and there were no serious complications such as infection, vascular injury, and nerve injury. The patients were followed up for 26.7 months on average (range, 12-42 months). At 6 weeks after operation, one patient had limited motion of the knee, the function was recovered after release under anesthesia; and one patient had joint space tenderness, which was relieved after conservative treatment. The total effective rate was 90.9% (20/22). At last follow-up, the anterior drawer test, Lachman test, and McMurray test were negative in all the cases. The visual analogue scale (VAS), Tegner activity level score, and Lysholm score were significantly improved at 12 months after operation when compared with preoperative scores (P<0.05). At 6-12 months after operation, complete healing was obtained in 7 cases, and partial healing in 11 cases, and nonunion in 4 cases based on MRI evaluation criteria by Crueset al. There was no rupture of reconstruc-tive ligament during follow-up. Conclusion Arthroscopic simultaneous both ACL reconstruction and suture of BHT can improve the symptoms, reduce the risk of re-tear of sutured meniscus effectively, delay degeneration of articular cartilage, and maintain the stability of the knee joint.

关键词: 关节镜; 前交叉韧带; 半月板; 桶柄样撕裂; 韧带重建

Key words: Arthroscopy; anterior cruciate ligament; meniscus; bucket-handle tear; ligament reconstruction

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