关节镜下AR缝合枪缝合外侧半月板撕裂的临床疗效观察

目的探讨分析外侧半月板体部层裂或纵向撕裂在关节镜下使用AR缝合枪全内垂直褥式缝合的临床疗效。方法本研究回顾性分析2017年1月至2017年12月,我科收治膝关节单纯外侧半月板体部撕裂(层裂或纵向撕裂)36例患者的临床资料,男13例,女23例;年龄16-41岁,平均(26.50±2.50)岁。36例患者中盘状半月板损伤7例。术中将撕裂外侧半月板修切白区内缘,保留红白区交界,体部层裂或纵裂新鲜化处理后行AR缝合枪全内垂直褥式缝合。术后根据Barrett标准门诊随访判断半月板的体部缝合临床愈合情况,采用重复测量方差分析比较不同时间视觉模拟评分(visual analogue scale,VAS)、膝关节主观功能评分(IKDC 2000评分)、膝关节功能评分(Lysholm评分)的差异来评估手术缝合疗效。术后12个月行膝关节MRI检查观察缝合部位恢复情况。结果本组36例患者均获随访,随访时间12-18个月,平均(15.0±2.3)个月。术后未出现感染、神经血管损伤、二次手术等并发症。根据Barrett标准评价,本组患者均获得半月板临床愈合。术后3个月、6个月、12个月的VAS评分为(1.10±0.12)分、(1.00±0.21)分、(0.90±0.32)分低于术前的(5.20±1.80)分,IKDC2000评分为(82.34±3.15)分、(85.34±5.17)分、(87.34±4.18)分高于术前的(40.51±5.54)分,Lysholm评分为(87.38±6.18)分、(88.52±4.19)分、(90.34±4.22)分高于术前的(42.11±6.82)分,差异具有统计学意义(P<0.05)。术后12个月复查MRI结果,34例(94.44%)甲级愈合,1例(2.78%)乙级愈合,1例(2.78%)未愈合。结论关节镜下采用AR缝合枪行全内垂直褥式缝合膝关节外侧半月板体部撕裂(层裂或纵裂),能有效缓解疼痛、提高患肢功能活动、促进半月板愈合,同时具有操作简单、并发症少等优势,经中短期临床随访其临床疗效显著,远期疗效需进一步随访追踪。

The Clinical Observation of Total Internal Vertical Mattress Suture with AR Suture Gun for Lateral Meniscus Tear Under Arthroscopy

Objective To investigate and analyze the short and medium term clinical effects of total internal vertical mattress suture with AR(Arthrex)suture gun under arthroscopy for lateral meniscus spallation or longitudinal tear.Methods The clinical data of 36 patients,including 13 males and 23 females,aged 16 to 41 with an average of(26.5±2.5)years,with simple lateral meniscus tear(spallation or longitudinal tear)in our department from January to December 2017 were retrospectively analyzed,including 7 discoid meniscus injuries.The outer meniscus was repaired and cut into the margin of the white area during the operation to preserve the junction of the red and white area,and the body layer or longitudinal tear.After freshness treatment,AR suture gun was used to suture the meniscus by vertical mattress suture method.The clinical healing of meniscus body suture was judged according to Barrett standard outpatient follow-up after operation.Visual analogue pain score(VAS score),subjective knee function score(IKDC 2000 score)and knee function at different time were compared by repeated measurement variance analysis.The difference of Lysholm score was used to evaluate the effect of surgical suture.The knee joint was examined by MRI 12 months after operation to observe the recovery of suture site.Results All 36 patients were followed up for 12 to 18 months(15.00±2.30).There were no complications such as infection,neurovascular injury and secondary operation.According to Barrett criteria,meniscus healing was achieved in all patients.VAS scores of 3 months,6 months and 12 months after operation were(1.10±0.12),(1.00±0.21),(0.90±0.32).The IKDC 2000 scores of 3 months,6 months and 12 months after operation were(82.34±3.15),(85.34±5.17),(87.34±4.18)significantly higher than those before operation(40.51±5.54),with statistical significance(P<0.05);the Lysholm scores of 3 months,6 months and 12 months after operation were(87.38±6.18),(88.52±4.19),(90.34±4.22)significantly higher than those before operation(42.11±6.82),the difference was statistically significant(P<0.05).The 12-month follow-up of MRI showed that 34 cases(94.44%)healed in grade A,1 case(2.78%)healed in grade B and 1 case(2.78%)did not heal.Conclusion Arthroscopic total internal vertical mattress suture with AR suture gun for lateral meniscus tear(spallation or longitudinal fissure)can effectively relieve pain,improve limb function and promote meniscus healing,and it has the advantages of simple operation and fewer complications.Its clinical efficacy is remarkable in short and medium term follow-up.Further followup and follow-up are needed for the long-term efficacy.