肌腱缝合修复半月板的器械设计及疗效观察

目的设计一套手术器械，实施以肌腱作为缝合材料的半月板修复技术，验证其可行性，并观察肌腱缝合修复半月板的疗效。方法按需设计新器械并改进现有器械。2005年10月-2006年12月，采用自行设计的器械以肌腱缝合半月板技术治疗45例单侧半月板损伤。男29例，女16例；年龄17～40岁，平均28岁。运动伤33例，交通事故伤5例，非运动跌伤3例，原因不明4例。病程3d～6个月，平均2个月。合并前交叉韧带损伤23例，后交叉韧带损伤6例。E．MRI提示半月板Ⅱ度损伤2例，Ⅲ度损伤43例。关节镜下见内侧半月板损伤39例，外侧半月板损伤6例。术前Lysholm评分（53．0±10.3）分。单纯半月板损伤者采用同种异体肌腱作为缝合材料，合并交叉韧带损伤者采用自体胭绳肌腱重建交叉韧带，并以制作韧带移植物后剩余的肌腱缝合半月板。结果共设计器械19件。临床应用45例均顺利完成手术，未出现神经血管损伤等并发症。术后均获随访，随访时间6～24个月，平均15个月。45例术膝疼痛症状缓解，无关节绞锁，Mcmurray征均为阴性。术后6个月Lysholm评分（87.8±9．2）分，与术前比较差异有统计学意义（P〈0．01）。结论临床应用表明新器械套件适合肌腱缝合半月板手术，且近期疗效良好。

DESIGN OF INSTRUMENTS FOR MENISCAL SUTURE WITH TENDON

OBJECTIVE: To design a new suit of instruments for meniscal suture with tondon, and then authenticate their feasibility and the therapeutic effect of the new technique. METHODS: Instruments were developed, including new ones and others which was improved according to the current instruments. From October 2005 to December 2006, 45 patients with meniscal injury were treated by meniscal suture with tendon. There were 29 males and 16 females, aged 17-40 years (mean 28 years). Injury was caused by sports in 33 cases, by traffic accident in 5 cases, by falling in 3 case and others in 4 cases. The disease course was 3 days to 6 months (mean 2 months). There were 23 cases accompanying with anterior cruciate ligament injury and 6 cases accompanying with posterior cruciate ligament injury. E-MRI showed 2 cases of degree II and 43 cases of degree III. Arthroscope showed that injury was at medial meniscus in 39 cases and at lateral meniscus in 6 cases. The pre-operational Lysholm score was 53.0 +/- 10.3. Autogeneic or xenogenic tendon was made into suture line guided by stitch at the two ends. The therapeutic effect of the new technique was authenticated by clinical results, including the change of symptoms and physical signs, and by comparing the pre-operational Lysholm score with the post one. RESULTS: Nineteen pieces of instruments were developed. All the operation were successful, with no harm to nerves and vessels. The follow-up was 6 months to 24 months (mean 15 months). At the last follow-up, all the symptoms disappeared, including pain, swelling and locking, etc. The Lysholm score after 6 months of operation was 87.8 +/- 9.2, showing statistically significant difference when compared with per-operation ( P < 0.01). CONCLUSION: It is feasible to suture injured menisci with the new instruments and technique. It is an effective way to repair menisci with tendon according to the short-term results.