关节镜下半月板修补缝合系统联合血凝块治疗半月板损伤

目的评价关节镜下半月板修补缝合系统(Fast-Fix)联合血凝块缝合半月板损伤的临床疗效。 方法选取青岛市市立医院骨关节与运动医学科2016年4月至2017年4月收治的31例采取Fast-Fix联合血凝块缝合半月板的患者进行临床研究，评价其术后疗效。其中包括男18例，女13例，年龄18～45岁，平均年龄(32±8)岁，经患者亲自了解目的及相关风险后，自愿参加试验，纳入标准为初次单侧半月板损伤，不合并其他关节内损伤，不合并下肢血管神经损伤；主观体征存在患膝疼痛、交锁症状，但无明显关节受限，可进行一般日常活动；排除标准为MRI示合并有膝关节内其他损伤、陈旧性半月板损伤、合并神经血管损伤、先天性膝关节发育畸形。在关节镜下应用半月板修补缝合系统联合血凝块修整缝合损伤的半月板。观察患者术后3月、术后6月的康复情况并进行视觉模拟评分法(VAS评分)、膝关节主观功能评分(IKDC 2000评分)、膝关节功能评分(Lysholm评分)，采用重复测量方差分析比较不同时间VAS评分、IKDC 2000评分、Lysholm评分的差异，评估其手术疗效。 结果所有患者均获得随访，术后均未出现膝关节疼痛、交锁、二次手术及其并发症。经数据分析，不同时间VAS评分差异存在统计学意义(F＝963.131，P<0.01)，术前VAS评分显著高于术后3月(t＝－33.897，P<0.01)、术后6月VAS评分(t＝－30.460，P<0.01)，而术后3月和术后6月相比较差异无统计学意义(t＝－1.000，P>0.05)；不同时间IKDC 2000评分(F＝4 688.837，P<0.01)和Lysholm评分(F＝11 544.044，P<0.01)差异均有统计学意义，术前IKDC 2000评分和Lysholm评分显著低于术后3月(t＝76.205，P<0.01；t＝128.766，P<0.01)和术后6月评分(t ＝78.183，P<0.01；t＝131.180，P<0.01)，而术后3月和术后6月IKDC 2000评分(t＝1.496，P>0.05)、Lysholm评分(t＝1.896，P>0.05)相比较差异并无统计学意义。 结论关节镜下半月板修补缝合系统(Fast-Fix)联合血凝块缝合半月板损伤可获得良好的术后疗效，但对于血凝块如何促进半月板愈合的机制尚不明确，仍需要进一步的试验研究。

Fast-Fix combined with blood clot in treatment of meniscus injury under arthroscope

ObjectiveTo discuss the clinical efficacy of the method of Fast-Fix combined with blood clot suture meniscus injury method under arthroscope. MethodsA clinical study was conducted, and the postoperative outcome was evaluated on 31 patients who underwent Fast-Fix combined with blood clot suture meniscus injury method, and admitted to the Department of Bone and Joint and Sports Medicine of Qingdao Municipal Hospital from April 2016 to April 2017. The subjects were 18 males and 13 females aged eight to 45 years, with an average age of (32±8) years. Patients voluntarily participated in the trial after learning about the risks and the purpose of the trial. Inclusion criteria: the initial unilateral meniscus injury, which does not involve other intra-articular injuries, or lower extremity vascular nerve injury; knee pain and interlocking, no obvious joint limitation or general daily activities. The patients with other injuries in the knee joint, old meniscus injury, neurovascular injury and congenital knee malformation were excluded. The damage, location, and extent of the meniscus were observed under arthroscopy to determine whether it was accompanied by damage in other joints or ligaments. Application of meniscus repair suture system combined with blood clot trimming suture was performed to treat meniscus injury under arthroscope. The patients were observed for rehabilitation at three months and six months after the surgery, and the visual analog scale (VAS) score, 2000 International Knee Documentation Committee(IKDC 2000)score, and Lysholm joint function score were performed. The repeated ANOVA was used to compare the differences of VAS score, IKDC 2000 score and Lysholm score at different time points. ResultsAll the patients were followed up without postoperative knee pain, interlocking, secondary surgery and complications. According to the data analysis, the difference of VAS scores at different time was statistically significant (F=963.131, P<0.01). The preoperative VAS score was significantly higher than that of the postoperative three months (t=-33.897, P<0.01), and six months after surgery, but there was no significant difference in VAS scores between three months and six months after surgery (t =-1.000, P >0.05). There were significant differences in IKDC 2000 scores (F =4688.837, P <0.01) and Lysholm scores (F =11544.044, P<0.01) at different times. The preoperative IKDC 2000 score and Lysholm score were significantly lower than those after three months (t =76.205, P <0.01; t =128.766, P <0.01) and after six months (t= 78.183, P <0.01; t=131.180, P <0.01). There was no significant difference in IKDC 2000 scores (t =1.496, P >0.05) and Lysholm scores (t =1.896, P >0.05) between three months and six months after the surgery. ConclusionGood postoperative outcomes can obtain from the method of Fast-Fix combined with clot suture meniscus injury method; the mechanism of blood clots promoting meniscus healing is still unclear, and need further research.