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前十字韧带损伤合并内侧半月板ramp损伤
引用本文:冯华,洪雷,耿向苏,张辉,王满宜.前十字韧带损伤合并内侧半月板ramp损伤[J].中华骨科杂志,2005,25(11):651-655.
作者姓名:冯华  洪雷  耿向苏  张辉  王满宜
作者单位:100035,北京积水潭医院创伤骨科
摘    要:目的探讨前十字韧带损伤合并内侧半月板ramp损伤的发生率、诊断方法、修补术及其临床疗效。方法2002年4月至2005年4月,共进行333例单纯前十字韧带损伤重建术,陈旧性损伤(>3个月)215例,急性损伤(<3个月)118例。合并内侧半月板ramp损伤者89例,其中85例需手术修补。手术取腘绳肌腱、自体或异体骨-髌腱-骨移植物重建前十字韧带,同时应用全内缝合方法,经两个后内入路配合经髁间窝入路,利用缝合钩修补ramp损伤。前十字韧带损伤中,ramp损伤的总发生率为26.7%,其中陈旧性损伤的发生率为30.7%,急性损伤为19.5%。结果可随访者75例(88.2%),随访5~41个月,平均20.2个月。随访时采用主观症状观察、临床查体、二次关节镜手术观察及MR检查。其中二次手术观察25例,MR复查21例。在可随访的75例患者中,所有患者的主观症状及临床查体均呈正常表现;在二次关节镜手术观察的25例中,均全部愈合。在经MR复查的21例中,18例完全愈合,3例部分愈合。结论大约1/3的前十字韧带损伤合并有内侧半月板ramp损伤,陈旧性损伤较新鲜损伤合并ramp损伤的发生率更高。在重建前十字韧带的同时应修补ramp损伤,全内缝合方法是修补ramp损伤的很好方法,可以达到很高的愈合率。

关 键 词:关节镜检查  前交叉韧带  半月板  胫骨
收稿时间:2005-07-27
修稿时间:2005-07-27

Anterior cruciate ligament injury with medial meniscus ramp lesion
FENG Hua, HONG Lei, GENG Xiang-su et al..Anterior cruciate ligament injury with medial meniscus ramp lesion[J].Chinese Journal of Orthopaedics,2005,25(11):651-655.
Authors:FENG Hua  HONG Lei  GENG Xiang-su
Abstract:Objective To describe the special ramp lesion, which involves the capsulomeniscal region of posterior horn of medial meniscus and most commonly occurs in association with anterior cruciate ligament(ACL) injury, pre- and intra-operative diagnosis methods, arthroscopy repair technique and follow-up results of arthroscopy second-look & MR review. Methods From April 2002 to April 2005, 89 cases of ACL injury with ramp lesions are enrolled in this series, among them 85 need operation repairing. Arthroscopic ACL reconstruction with hamstring or B-PT-B autograft or allograft and all-inside medial meniscus repair through 2 posteromedial portals and transcondylar portal have been performed. Generally, the ramp lesion accounts for 26.7% of ACL injury, 30.5% for chronic and 19.5% for acute injury respectively. Results Of the repaired ramp lesion cases, 75 cases(88.2%) are available for follow-up, with the duration from 5 to 41 months (mean, 20.2 months). 25 cases underwent arthroscopic second-look and 21 cases received MR evaluation. The study include subjective symptom, clinical examination, and arthroscopic second-look as well as MR review. All of the repaired cases present normal subjective and objective evaluations, and all the 25 second-look cases show completely healing. Of the 21 MR follow-up cases, 18 completely healed, 3 partial healed. Conclusion About 1/3 ACL injuries are associated with medial meniscus ramp lesion, and the morbidity is higher in old injuries than acute injuries. For this combined lesion, one stage ACL reconstruction and meniscus repair was recommended. All-inside meniscus repair is a satisfactory technique for ramp lesion and can get high healing rate.
Keywords:Arthroscopy  Anterior cruciate ligament  Menisci  tibial  
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