关节镜下联合修补技术治疗内侧半月板桶柄样撕裂20例临床分析

目的 探讨关节镜下联合修补技术治疗内侧半月板桶柄样撕裂的临床疗效.方法 采用关节镜下联合修补技术修补20例(20个)内侧半月板桶柄样撕裂,均累及内侧半月板后角至前体部区域.半月板体部和前角采用标准的自内向外缝合;半月板后角采用全关节内缝合:经两个后内侧入路在关节内完成垂直褥式缝合.单纯的红-白交界处撕裂修补后局部植入血凝块促进愈合,合并前十字韧带损伤者同时行韧带重建手术.结果 20例患者均得到随访,随访时间5～36(19.2±2.3)个月.其中无症状18例,关节间隙压痛2例.20个半月板经MRI复查,完全愈合15个,部分愈合5个.术后膝关节功能Lysholm评分82～97(90.3±1.5)分,与术前的45～69(56.7±2.0)分比较差异有统计学意义(P=0.024).结论 对于发生在红-红或红-白交界处的内侧半月板桶柄样撕裂,关节镜下联合修补技术是安全、可靠的方法.

Abstract：

Objective To investigate the arthroscopic inside-out repairing technique(hybrid suture technique) for bucket-handle tear of inside meniscus and present the short-term clinical outcome. Methods Twenty patients with 20 repairable inside meniscus tears were enrolled. With arthroscopic technique,the midbody portion and anterior portion of the lesion were repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement. For the most posterior portion, all-inside suture technique with two posterior portals were performed. For isolated red-white zone tears,fibrin clot was implanted into the repaired region for enhancing the healing pro-ACL injuries were reconstructed simultaneously. Results Twenty patients with 20 meniscal repairs were available for 5-36 (19.2 ± 2.3)months follow-up. Eighteen cases were asymptomatic at the latest clinical evaluation,and joint space tenderness in 2 cases. Twenty cases received MRI evaluation during follow-up, showing that 15 menisci were completely healed, 5 partially healed. Postoperative Lysholm scores of the knee joint function 82-97(90.3 ±1.5) points] were significantly improved compared with their preoperative scores 45-69 (56.7 ± 2.0)points] (P = 0.024).Conclusion For meniscal tears involving red-red and red-white zones,arthroscopic hybrid suture technique provides stable strength along the whole length of injured region, and consequently achieves satisfactory clinical outcomes.

Arthroscopic hybrid suture technique for repairing 20 bucket-handle tear of inside meniscus

Objective To investigate the arthroscopic inside-out repairing technique(hybrid suture technique) for bucket-handle tear of inside meniscus and present the short-term clinical outcome. Methods Twenty patients with 20 repairable inside meniscus tears were enrolled. With arthroscopic technique,the midbody portion and anterior portion of the lesion were repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement. For the most posterior portion, all-inside suture technique with two posterior portals were performed. For isolated red-white zone tears,fibrin clot was implanted into the repaired region for enhancing the healing pro-ACL injuries were reconstructed simultaneously. Results Twenty patients with 20 meniscal repairs were available for 5-36 (19.2 ± 2.3)months follow-up. Eighteen cases were asymptomatic at the latest clinical evaluation,and joint space tenderness in 2 cases. Twenty cases received MRI evaluation during follow-up, showing that 15 menisci were completely healed, 5 partially healed. Postoperative Lysholm scores of the knee joint function 82-97(90.3 ±1.5) points] were significantly improved compared with their preoperative scores 45-69 (56.7 ± 2.0)points] (P = 0.024).Conclusion For meniscal tears involving red-red and red-white zones,arthroscopic hybrid suture technique provides stable strength along the whole length of injured region, and consequently achieves satisfactory clinical outcomes.