关节镜下应用FasT-Fix缝合器治疗半月板桶柄样撕裂损伤

目的探讨关节镜下应用Fas T-Fix缝合器在半月板桶柄样撕裂损伤修复中的临床疗效。方法采用Fas T-Fix缝合器在关节镜下对28例半月板桶柄样撕裂损伤患者进行全内半月板缝合手术。结果患者均获得随访,时间3～12个月。根据Barrett et al临床愈合标准评价:25例临床愈合;3例未愈合,二期行半月板切除术。末次随访时,28例患者Lysholm评分由术前43～65(57. 8±6. 3)分提高到87～96(93. 2±2. 7)分(P 0. 01)。结论关节镜下应用Fas T-Fix缝合器缝合修复半月板桶柄样撕裂损伤临床疗效较好。     

关节镜下复位缝合富血小板血浆注射治疗陈旧性半月板桶柄样撕裂

[目的]介绍陈旧性内侧半月板桶柄样撕裂镜下复位缝合修复,结合富血小板血浆注射的手术技术与初步结果。[方法]对1例28岁陈旧性内侧半月板桶柄样撕裂23年的患者行镜下复位缝合,同时行富血小板血浆注射。镜下全面探查关节内病变,将半月板撕裂部和关节囊残缘打磨出新鲜创面,采用由内向外"U"形缝合半月板2针,牵拉关节外侧缝线,在关节镜直视下松解半月板前、后角挛缩部分,使半月板桶柄撕裂缘与关节囊缘逐渐靠拢,将缝线打结固定。再采用Fast-fix 360将半月板体部至后角撕裂部分全内缝合。探查半月板缝合后撕裂部分复位满意,稳定性良好。将制备好的PRP共4 ml沿内侧膝关节间隙半月板的体部及后角等部位,多点穿刺注射。[结果]术后患者疼痛和关节交锁等症状消失,逐步恢复伤膝活动。术后2个月,患者恢复运动能力,无明显不适,复查MRI显示左膝内侧半月板形态完整、均质,无明显异常信号。[结论]对陈旧性内侧半月板桶柄样撕裂进行适当松解仍可缝合修复,富血小板血浆注射有利于陈旧性半月板缝合修复后愈合。     

外侧半月板桶柄样撕裂联合缝合技术的应用

 目的 探讨关节镜下自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂的临床效果。方法 2004年11月至2009年11月,应用关节镜下联合缝 合技术修复外侧半月板桶柄样撕裂17例,男10例,女7例;年龄17~42岁,平均27.8岁。使用自内向外缝合技术对外侧半月板腘肌腱前方区域的撕裂进行缝合,使 用全内缝合技术对半月板后角区域的撕裂进行缝合。随访时进行体格检查、MR检查和二次关节镜探查,评估半月板愈合情况。结果 13例患者获得随访,随访时 间1~5年,平均23.7个月。随访期间症状消失者12例（92.3％,12/13）,绞锁复发1例（7.7％,1/13）。MRI证实半月板完全愈合11例（84.6％,11/13）,部分 愈合1例（7.7％,1/13）,不愈合1例（7.7％,1/13）。12例患者行二次关节镜探查,其中完全愈合10例（83.3％,10/12）,部分愈合1例（8.3％,1/12）, 未愈合1例（8.3％,1/12）。结论 应用自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂,经术后MRI和二次关节镜探查证实半月板愈合率超过90%。     

桶柄样撕裂半月板缝合的临床及影像效果

[目的]分析半月板桶柄样撕裂行关节镜下半月板缝合患者临床及MRI表现,评估术后效果。[方法]回顾性分析本院2012年8月～2015年8月关节镜下桶柄样撕裂半月板行复位缝合,伴前交叉韧带断裂者同时行前交叉韧带重建手术的25例患者,男21例,女4例,平均年龄(28.07±7.08)岁。采用Lysholm、IKDC评分和MRI检查评价治疗效果。[结果]所有患者均顺利完成手术,镜下证实内侧半月板损伤21例,外侧半月板损伤4例;撕裂部位位于红区17例,位于红白区8例;合并前交叉韧带断裂18例,未合并前交叉韧带断裂7例。所有患者随访13～24个月,平均(17.04±2.23)个月。随访过程中,2例单纯半月板缝合患者术后再次出现症状,再次行关节镜下部分切除未愈合的撕裂部分半月板。其余23例患者Lysholm评分由术前的(21.32±5.09)分提高到末次随访时(91.52±4.05)分(P0.05),IKDC膝关节功能主观评分由术前(25.00±4.59)分提高到末次随访时(91.32±4.26)分。MRI复查见半月板撕裂处T2质子相信号较术前明显降低,半月板形态恢复,未见明显新发撕裂,半月板愈合良好。[结论]半月板桶柄样撕裂经关节镜下缝合修复术临床效果满意,合并前交叉韧带损伤者同时进行前交叉韧带重建的效果优于单纯半月板缝合。     

关节镜下半月板切除与缝合修补治疗半月板桶柄样撕裂的临床对比研究

目的 通过对比分析关节镜下缝合修补术和半月板次全/全切除术治疗半月板桶柄样撕裂的临床疗效,探讨缝合修补治疗半月板桶柄样撕裂的应用价值.方法 回顾性分析2005年1月至2009年1月经关节镜治疗的34例(34膝)半月板桶柄样撕裂患者,其中采用全内缝合或全内和外内联合缝合的患者15例(A组),男9例,女6例;平均年龄为(30.3±6.8)岁;受伤至手术时间平均为(10.6±3.8)d;内侧半月板损伤12例,外侧半月板损伤3例.同期采用半月板次全/全切除术19例(B组),男11例,女8例;平均年龄为(29.1±5.5)岁,受伤至手术时间平均为(10.2 ±2.8)d;内侧半月板损伤15例,外侧半月板损伤4例.记录两组的手术时间,并通过患者的症状、体征、关节活动度和Lysholm评分等比较两组患者疗效.结果 手术时间:A组为(71.3±8.8)min,B组为(45.7±9.4)min,差异有统计学意义(P<0.05).两组患者术后获12～24个月(平均17.2个月)随访.术后6个月关节活动度A组平均为138.7°±5.1°,B组平均为136.0°±4.6°;术后12个月关节活动度A组平均为140.1°±3.1°,B组平均为139.8°±3.3°,两组比较差异均无统计学意义(P>0.05).术后6个月Lysholm评分A组平均为(90.1±7.1)分,B组平均为(89.9±6.9)分,差异元统计学意义(P>0.05);术后12个月Lysholm评分A组平均为(94.5 ±3.9)分,B组平均为(90.3±5.8)分,差异有统计学意义(P<0.05),A组优于B组.结论 对于大型半月板撕裂,采用合适的缝合技术可使撕裂的全长段获得有效修补,能尽可能多地保留半月板的功能,临床疗效优于传统的半月板次全/全切除术.     

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

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9h~4年,中位时间40d。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、Mc Murray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(P0.05)。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。     

四肢关节专用MRI对膝关节半月板桶柄样撕裂的诊断价值

目的探讨膝关节半月板桶柄样撕裂的MRI征象及其诊断价值。方法回顾分析膝关节半月板桶柄样撕裂23例,所有病例均经过四肢关节专用MRI检查并经关节镜证实。由2名有经验的放射科医师进行盲法阅片,记录并评价各征象的诊断价值。结果23例共见半月板桶柄样撕裂23个,其中发生于内侧半月板者16例(69.6%),外侧半月板者7例(30.4%)。出现领结消失征15例(65.2%),双前角征9例(39.1%),半月板翻转征3例(13.0%),髁间碎片征19例(82.6%),双后交叉韧带征7例(30.4%),后角比例失调征8例(34.8%)。序列试验显示各征象联合诊断时特异性明显提高,其中髁间碎片征和双后交叉韧带征联合的特异度达100%。结论MRI是半月板桶柄样撕裂理想的无创检查方法,有利于该疾病的术前诊断和手术计划制定。     

关节镜下双面立体缝合修复半月板桶柄状撕裂的中期疗效

目的探讨关节镜下应用双面立体缝合修复半月板桶柄状撕裂的中期疗效。方法 2009年1月-2012年12月,收治38例半月板桶柄状撕裂患者。男26例,女12例;年龄19~42岁,平均32岁。致伤原因:运动伤21例,交通事故伤11例,其他伤6例。左膝15例,右膝23例。伤后至手术时间为2 d~6个月,平均2.5个月。MRI提示半月板Ⅲ度损伤,内侧半月板22例、外侧半月板16例。于关节镜下采用上层面和下层面水平褥式缝合修复治疗。结果患者术后切口均Ⅰ期愈合,未出现切口感染、不愈合等并发症。38例均获随访,随访时间18~36个月,平均24.5个月。按照Barrett等的标准,半月板均成功修复。术后6个月、12个月及末次随访时,患者膝关节Lysholm评分及膝关节活动度均显著优于术前,差异均有统计学意义(P0.05)。结论关节镜下双面立体缝合修复半月板桶柄状撕裂,具有缝合牢固、愈合率高等特点,可取得满意的中期疗效。     

前交叉韧带合并内侧半月板桶柄样撕裂同期修复12例分析

目的探讨前交叉韧带(Anterior cruciate ligament,ACL)合并内侧半月板桶柄样撕裂同期修复的临床疗效。方法对2013年10月至2015年12月,本院经治的ACL合并内侧半月板桶柄样撕裂患者12例,进行随访。男7例,女5例;年龄19~55岁,平均29.2岁。左膝5例,右膝7例,病程2天~1.6年。临床主要表现为膝关节不稳,疼痛,弹响,绞锁。本组均采用同期ACL重建联合内侧半月板缝合术,术前、术后采用Lysholm评分及IKDC评分评价膝关节功能,根据Barrett标准评判半月板愈合情况。结果本组12例,12例均获随访6个月~1年,平均7.8个月,术后3个月和6个月随访Lysholm评分为:(76.5±2.2),(94.8±1.4),较术前(36.6±4.3)明显提高,术后3个月和6个月随访IKDC评分依次为:(79.5±0.8),(94.4±0.9),较术前(39.8±3.3)明显改善。MRI示半月板愈合9例,1例因再次撕裂行手术治疗,愈合率75.0%。结论 ACL合并内侧半月板桶柄样撕裂应早期、同期修复,愈合率高,临床效果满意。     

“环抱”缝合法修复内侧半月板桶柄状撕裂中期疗效观察

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。     

Kombinierte Verletzung des Innen- und Außenmeniskus und des vorderen Kreuzbandes

THE PROBLEM: Combined injury of the medial and lateral meniscus and the anterior cruciate ligament. THE SOLUTION: One-stage arthroscopic treatment of all injuries. Repair of the bucket-handle tears with sutures and arrow-shaped implants. SURGICAL TECHNIQUE: Arthroscopy of the knee joint, repositioning of the buckethandle tears of the medial and lateral menisci. Evaluation of the stability of the menisci without sutures, insertion of horizontal and vertical sutures through the menisci in inside-out technique, refixation of the posterior horns with arrow-shaped meniscus implants. Reconstruction of the anterior cruciate ligament with a patellar tendon transplant. Knotting of the suture loops through the menisci directly onto the capsule. RESULT: Stable knee joint capable of load bearing and without signs of irritation after 12 weeks with a range of motion of 0/0/130 degrees. Slight muscle deficit in the right thigh.     

Microvasculature of the human medial meniscus: operative findings.

The purpose of our study was to weigh the probability of a successful meniscus repair on the basis of the microvasculature of the human medial meniscus. In a series of 105 patients who underwent an anterior cruciate ligament reconstruction between January 1985 and December 1986, we chose the 40 patients who had a subtotal medial meniscectomy (38%) to study the microvasculature of the human medial meniscus adequately; the other patients had either an intact meniscus (23%), a meniscus repair (29%), or an already removed meniscus (10%). Forty medial menisci, from 40 male patients with an average age of 27 years, having an anterolateral and/or anteromedial chronic knee laxity and an associated meniscal pathology, were subdivided into two groups: (a) 20 tears restricted to the posterior horn, and (b) 20 bucket-handle tears observed under light microscopy. Meaningful capillary plexuses penetrating into the meniscal stroma were found in 18 of 40 menisci (45%). They were easier to identify in posterior horn tears (55%) than in bucket-handle tears (35%), and were found especially in younger patients (22 years on the average). Therefore, we encourage meniscus repairs even in chronic tears, particularly in younger patients and in posterior-horn tears.     

Stage-based treatment by partial meniscectomy, meniscal refixation and transplantation

Clinical and experimental studies have demonstrated that the meniscus is important for normal knee function. Loss of meniscus results in abnormal load transmission across the knee and may lead to degenerative joint disease. Preservation of meniscal tissue is therefore important. About 10 % of all meniscal tears are repairable. The most successful repairs occur in younger patients who have an acute, vertical tear in the vascular portion of the meniscus. Currently, arthroscopic meniscal repair procedures include the inside-out, the outside-in and the all-inside technique. Vertical suture techniques are superior to horizontally placed sutures. From a biomechanical point of view, 2-0 to 1 sutures are recommended for suture repair. Various meniscus implants are also available for meniscal repair. The initial fixation strength of the implants is lower compared to vertical sutures. A combination of suture techniques and implants might be a treatment option in posterior meniscal lesions. The collagen meniscus implant has been designed to support tissue ingrowth after segmental medial meniscectomy. Although fibrocartilage matrix formation has been shown, long-term clinical follow-ups are still required. Meniscal allograft transplantation may be indicated in limited situations. Younger patients with meniscal deficiency due to previous meniscectomy who have only early arthrosis, normal axial alignment, and a stable knee may currently considered appropriate candidates for meniscal transplantation.     

All-Inside Suture Technique Using Anterior Portals in Posterior Horn Tears of Lateral Meniscus

Methods for the repair of meniscal tears include inside-out, outside-in, and all-inside techniques. In this article an all-inside technique is proposed for the posterior horn of the lateral meniscus that takes advantage of the capacious posterolateral recess when the knee is flexed. A device consisting of a large needle with a buttonhole in the tip (previously used for inside-out suture of the medial meniscus) is used. This technique uses only anterior portals (anteromedial and anterolateral portals and an accessory lateral or transpatellar tendon portal). The arthroscope is inserted through the accessory portal. Once the tear has been located and its edges refreshed, the suture device is placed anterolaterally. The tip of the needle is loaded with suture and passed through both sides of the tear and into the posterolateral recess of the knee (without exiting the capsule). The suture tail is recovered with the use of a suture retriever through the anteromedial portal. Next, the suture retriever is inserted through the anterolateral portal to once again retrieve and shuttle the tail before completion of an arthroscopic knot. In addition to the ease of the technique, use of this simple, reusable device adds the benefit of low cost when compared with other techniques.     

Posterior trans-septal portal for arthroscopic surgery of the knee joint

Summary: The authors introduce a safe arthroscopic technique of making a portal through the posterior septum of the knee joint, posterior to the posterior cruciate ligament (PCL). This posterior trans-septal portal makes it possible for the arthroscope or the working instruments inserted through the posteromedial portal to reach the posterolateral compartment. With this portal, complete arthroscopic visualization of the posterior compartment and easier arthroscopic procedures for the posterior compartment of the knee joints are possible, including the posterior and posterosuperior aspect of the both femoral condyles, the posterior horns of both menisci, the posterior and inferior portion of the PCL, the posterior meniscofemoral ligament, the posterior septum, and the posterior capsule. We have used this technique in more than 150 knees for arthroscopic total synovectomy for arthritis of various origins, arthroscopic PCL reconstructions, arthroscopic removal of encapsulated loose bodies or tumors located behind the PCL, arthroscopic repairs of tears in the posterior horns of the medial menisci using the all-inside technique, arthroscopic pullout suture fixation of the avulsion fracture of tibial attachment of PCL, and others. No complications such as injuries of the popliteal neurovascular structures have occurred in our experience.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 774–779     

Arthroscopic verification of meniscus repair]

The purpose of this study was to verify the arthroscopic meniscus repair by second-look arthroscopy. From November 2001 to October 2005, 28 meniscus (18 medial and 10 lateral) were repaired in 26 patients (two patients had both menisci in one knee repaired). There were 11 females and 15 males. The average age at surgery was 25.5 (range, 13 to 52 years of age). The indication for repair was a full-thickness, vertical tear > or = 8 mm. Meniscus repair was combined with partial meniscectomy of posterior horn because of horizontal tear in 3 cases. In 1 zone 14 meniscus were injured and in 2 zone--also 14 meniscus, according to Cooper's classification. All patients had anterior cruciate ligament rupture. The average time interval between the injury and the repair was 22 weeks (range, 2 weeks to 2 years). The inside-out suture was used in 18 repairs, all inside--3 repairs, outside-in--2 repairs and a mixed technique--5 repairs. Arthroscopic evaluation of meniscus repair was performed on average after 15 weeks (range, 2 months to 37 weeks) since the suture. That was done during the second stage of treatment--ACL reconstruction. There were 78.6% of completely healed repairs, 10.7% of incompletely healed and 10.7% were not healed.     

A new, all-inside technique for meniscus repair.

A new method for arthroscopic meniscal repair using sutures with multiple knots was developed, and its mechanical strength was evaluated. Sutures are passed arthroscopically through the torn meniscus using a needle with a cleft in its tip, and when the needle is withdrawn, knots are placed both in the meniscus and the joint capsule. Our method does not require additional skin incisions and can be performed for repair of posterior tears. Furthermore, this all-inside technique minimizes the risk of popliteal neurovascular injury. Biomechanical analysis using bovine menisci showed that the maximum frictional force between the suture and meniscus was greater than the maximum strength of a suture itself. Our method is simple and rapid, making it easy to insert multiple sutures to achieve adequate stability.