关节镜下建立髁间窝通道治疗内侧半月板后角复杂破裂

目的 :探讨在关节镜下建立髁间窝通道并经该通道治疗内侧半月板后角复杂破裂。方法 :对127例经过髁间窝通道施行了半月板部分切除成形术的骨关节炎病例进行分析总结。127例患者均存在内侧半月板后角复杂裂,男24例,女103例;年龄45~78岁,平均67岁;127例中有112例通过3切口(常规前内侧切口、前外侧切口、高位前外侧切口)顺利完成内侧半月板后角部分切除成形术,有15例通过4切口(常规前内侧切口、前外侧切口、高位前外侧切口、后内侧切口)来完成手术。从4个方面进行评价:该方法对半月板后角部位能否全面便利观察、器械能否便利抵达靶部位、对相邻关节软骨的损伤情况和手术时间(处理半月板的时间)。结果:所有病例的半月板后角后根都能被全面清晰观察,器械都能便利地抵达靶部位,无软骨的医源性破坏发生,3切口情况下内侧半月板后角部位部分切除成形术的时间为5~10 min,4切口的时间为10~30 min。结论:在关节镜下建立髁间窝通道并经此通道治疗内侧半月板后角复杂破裂,方便快捷,最大程度减少了对关节软骨的医源性损伤。

Effects of creating a tunnel through intercondylar fossa under arthroscopy for the treatment of complex tears at the medial meniscus posterior horn

Objective: To discuss the advantages of the arthroscopic treatment for complex tears of the medial meniscus posterior horn by creating a tunnel passageway through the intercondylar fossa.Methods: All 127 patients including 24 males and 103 females with complex tears at the medial meniscus posterior horn were reviewed. The age of all patients ranged from 45 to 78 years old,with an average of 67 years old. All 127 patients were treated with partial meniscectomy,in which 112 patients were treated with partial meniscectomy smoothly with three incisions (anterior medial incision,anterior lateral incision,high anterior lateral incision),and 15 patients were treated with four incisions (anterior medial incision,anterior lateral incision,high anterior lateral incision,posterior medial incision). Four aspects were estimated:whether the meniscus posterior horns could be observed totally and conveniently,whether tools could be pushed to target area conveniently,the damage of adjacent cartilages,operation time(the operation time of partial meniscectomy).Results: Posterior horns of all patients were totally and conveniently observed,tools were conveniently pushed to the target area in all cases,and all the cases had no iatrogenic injuries at adjacent cartilages. The operation time of partial meniscectomy at posterior horns with three incisions ranged from 5 to 10 minutes,and it ranged from 10 to 30 minutes with four incisions.Conclusion: It is very convenient and fast of the arthroscopy to treat complex tears of the medial meniscus posterior horn by creating a tunnel through the intercondylor fossa. Iatrogenic injuries of the adjacent cartilages were prevented to the greatest extent.