半月板桶柄样撕裂的关节镜下修补:61例2～5年随访

背景:半月板的桶柄样撕裂如未经早期修补则要采取半月板切除,可导致膝关节退变的加速,但目前有关半月板的桶柄样撕裂关节镜下修补的长期、大样本报道较少.目的:回顾性分析半月板桶柄样撕裂的关节镜下修补疗效.分析半月板桶柄样撕裂的术前诊断、修补技术、疗效评估及影响因素,探讨大型半月板撕裂理想的修复途径.方法:于2002-05/2005-11在北京积水潭医院运动医学中心连续完成共90例关节镜下半月板桶柄样撕裂修补手术.对90例患者中的61例、63个半月板进行了2年以上的随访,平均随访期38个月(24～66个月).半月板桶柄撕裂的修补手术适应证为:红-红区及红-白区损伤、具备可复位性、半月板组织无复合撕裂及明显变性.结果与结论:在可随访的61例患者中,有51例(84%)的53个半月板经过二次手术探查.61例患者中53例(87%)无临床症状;4例(6%)部分临床症状;4例(6%)交锁复发.二次关节镜检查发现完全愈合的半月板有44个(83%);部分愈合者5个(9%),不愈合者4个(7%).总体评估失效率为8%(5/63),成功率92%(包括完全愈合、部分愈合、无临床症状及部分临床症状者).通过2～5年的随访结果表明对于发生在红-红区或红-白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,修复效果较好.

Arthroscopic repair for bucket-handle meniscus tears A 2-to 5-year follow-up of 61 patients

BACKGROUND: Unrepaired bucket handle meniscus tear(BHMT)could result in partial or total meniscectomy,which aggravates the degeneration of knee joint.The long-term,large sample studies regarding the success rate of BHMT repair are few.OBJECTIVE: To retrospectively analyze the clinical result of arthroscopic BHMT repair and explore the preoperative diagnosis,repair technique,treatment effect evaluation and influential factors,so as to investigate ideal repair method of large meniscus tear injury.METHODS: From May 2002 to November 2005,90 patients with repairable BHMT were treated in Sports Medical Center of Beijing Jishuitan Hospital.Of the 90 patients,61(63 menisci)were followed up for over 2 years with an average duration of 38months(24-66 months).The indications of BHMT repair include red-red area and red-white area injuries,reductable,meniscus with no compound tear or degeneration.RESULTS AND CONCLUSION: Of the 61 followed up patients,53 menisci in 51 patients(84%)were assessed by second-look arthroscopy; 53 of 61 patients(87%)were asymptomatic,4(6%)patients were partial asymptomatic and 4(6%)had recurrent locking showing failure.Second-look arthroscopic examination showed that 44 menisci(83%)were healed completely,5(9%)partially healed,and 4(7%)not healed.The total failure rate was 8%(5/63),and success rate was 92%,including complete healed,partial healed,asymptomatic and partial asymptomatic patients.For large bucket-handle meniscus tears involving red-red and red-white zones,reliable arthroscopic hybrid suture technique,provides stable suture strength along the whole length of injured region and consequently achieves improved clinical outcomes in combination with anterior cruciate ligament.