本文選題：關(guān)節(jié)鏡　切入點：前交叉韌帶　出處：《中國修復(fù)重建外科雜志》2017年05期

【摘要】：目的探討關(guān)節(jié)鏡下前交叉韌帶(anterior cruciate ligament,ACL)重建聯(lián)合半月板縫合修補術(shù)治療ACL損傷合并半月板桶柄樣撕裂(bucket-handle tear,BHT)的臨床療效。方法將2013年1月—2014年4月收治并符合選擇標(biāo)準(zhǔn)的22例(22膝)ACL損傷合并半月板BHT患者納入研究。其中,男14例,女8例;年齡15~44歲,平均30.68歲。左膝10例,右膝12例。內(nèi)側(cè)半月板損傷14例,外側(cè)8例。初次受傷至入院時間為9h~4年,中位時間40d。于關(guān)節(jié)鏡下首先行半月板縫合修補術(shù),然后行ACL單束重建。結(jié)果術(shù)后患者切口均Ⅰ期愈合,均未出現(xiàn)感染、血管神經(jīng)損傷等嚴(yán)重并發(fā)癥。22例患者均獲隨訪,隨訪時間12~42個月,平均26.7個月。1例術(shù)后6周關(guān)節(jié)功能活動仍受限,經(jīng)麻醉下手法松解后功能恢復(fù)良好;1例存在關(guān)節(jié)間隙壓痛,經(jīng)保守治療后疼痛緩解。臨床有效率為90.9%(20/22)。末次隨訪時,患者前抽屜試驗、Lachman試驗、Mc Murray試驗均為陰性。術(shù)后12個月疼痛視覺模擬評分(VAS)、Tegner運動水平評分、Lysholm評分均較術(shù)前顯著改善,比較差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)后6~12個月行MRI復(fù)查,參考Crues等的MRI評估標(biāo)準(zhǔn),7例完全愈合,11例部分愈合,4例不愈合。隨訪期間均無ACL再斷裂發(fā)生。結(jié)論關(guān)節(jié)鏡下半月板縫合修補聯(lián)合ACL單束重建治療ACL損傷合并BHT,能有效緩解臨床癥狀、降低半月板再次撕裂概率,延緩關(guān)節(jié)軟骨退行性變,維持膝關(guān)節(jié)穩(wěn)定性。
[Abstract]:Objective to investigate the clinical effect of arthroscopic anterior cruciate ligamentum reconstruction combined with meniscus suture repair in the treatment of ACL injury with bucket-handle laceration.Methods from January 2013 to April 2014, 22 patients with meniscus BHT were included in the study.Among them, there were 14 males and 8 females, aged 1544 years with an average of 30.68 years old.There were 10 cases of left knee and 12 cases of right knee.Medial meniscus injury was found in 14 cases and lateral meniscus injury in 8 cases.The time from first injury to admission was 9 h ~ 4 years and the median time was 40 d.Meniscus suture repair was performed under arthroscopy, and then ACL single bundle reconstruction was performed.Results all the incisions healed in the first stage without infection. All the 22 patients were followed up with severe complications such as vascular and nerve injury. The follow-up time was 12 ~ 42 months (mean 26.7 months), and the function of joint function was still limited 6 weeks after operation in 1 cases (average 26.7 months).After anaesthesia, 1 case had tenderness of joint space and the pain was relieved after conservative treatment.The clinical effective rate was 90.9 / 20 / 22.At the last follow-up, the Lachman test and MC Murray test were all negative.The visual analogue score of pain and the Lysholm score of Tegner motor level were significantly improved at 12 months after operation, and the difference was statistically significant (P 0.05).MRI was performed 6 ~ 12 months after operation. According to the MRI evaluation criteria of Crues et al, 7 cases were completely healed and 11 cases were partially healed and 4 cases were nonunion.No ACL rerupture occurred during follow-up.Conclusion meniscus suture repair combined with ACL single bundle reconstruction under arthroscopy can effectively relieve the clinical symptoms, reduce the probability of meniscus retear, delay the degeneration of articular cartilage and maintain the stability of knee joint.
【作者單位】： 山東中醫(yī)藥大學(xué);山東中醫(yī)藥大學(xué)附屬醫(yī)院手術(shù)室;山東中醫(yī)藥大學(xué)附屬醫(yī)院運動損傷骨科;
【分類號】：R687.4
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本文編號：1702514