【摘要】：目的探討"環(huán)抱"縫合法修復(fù)內(nèi)側(cè)半月板桶柄狀撕裂(bucket-handle tear,BHT)的中期療效。方法總結(jié)2011年3月—2013年6月采用關(guān)節(jié)鏡下"環(huán)抱"縫合法修復(fù)內(nèi)側(cè)半月板BHT的78例(78膝)患者臨床資料。男57例,女21例;年齡16~39歲,平均28.3歲。致傷原因:運(yùn)動損傷61例,交通事故傷12例,其他傷5例。新鮮損傷35例,陳舊性損傷43例。合并前交叉韌帶損傷65例。術(shù)前國際膝關(guān)節(jié)文獻(xiàn)委員會(IKDC)評分、Lysholm評分、Tegner評分分別為(48.2±6.3)、(43.6±4.7)、(2.5±0.6)分。MRI檢查示半月板Ⅲ度撕裂。術(shù)后采用Barrett等的評價標(biāo)準(zhǔn)、MRI檢查、二次關(guān)節(jié)鏡檢查評估半月板愈合情況,并采用IKDC評分、Lysholm評分和Tegner評分評價膝關(guān)節(jié)功能。結(jié)果術(shù)后切口均Ⅰ期愈合,無關(guān)節(jié)感染、異物排斥等并發(fā)癥發(fā)生。患者均獲隨訪,隨訪時間26~63個月,平均42.8個月。2例術(shù)后1年內(nèi)BHT復(fù)發(fā)。末次隨訪時,根據(jù)Barrett等的標(biāo)準(zhǔn),72例半月板達(dá)臨床愈合,臨床愈合率為92.3%。IKDC評分、Lysholm評分、Tegner評分分別為(81.5±5.1)、(86.9±3.9)、(6.2±0.5)分,與術(shù)前比較差異均有統(tǒng)計學(xué)意義(t= 14.598,P=0.000;t= 18.478,P=0.000;t= 3.362,P=0.002)。MRI復(fù)查示,末次隨訪時56例半月板完全愈合,15例部分愈合,7例全層面不愈合,總愈合率為91.0%(71/78)、完全愈合率為71.8%(56/78)。21例于術(shù)后18~49個月行二次關(guān)節(jié)鏡探查,其中17例半月板達(dá)完全愈合,4例為部分愈合,總愈合率為100%(21/21)、完全愈合率為81.0%(17/21);均無新撕裂出現(xiàn)。結(jié)論采用關(guān)節(jié)鏡下"環(huán)抱"縫合法修復(fù)內(nèi)側(cè)半月板BHT,具有縫合牢固、對半月板血供影響小的特點,可取得滿意的中期療效。
[Abstract]:Objective to investigate the mid-term curative effect of medial meniscus barrel shank tear (bucket-handle tear,BHT) repaired by encircling suture. Methods from March 2011 to June 2013, 78 patients (78 knees) with medial meniscus BHT were treated with arthroscopic "encircling" suture. There were 57 males and 21 females, aged 1639 years with an average age of 28.3 years. The causes of injury were 61 cases of sports injury, 12 cases of traffic accident and 5 cases of other injuries. 35 cases of fresh injury and 43 cases of old injury. 65 cases were complicated with anterior cruciate ligament injury. The scores of (IKDC), Lysholm and Tegner were (48.2 鹵6.3), () 鹵4.7), (2.5 鹵0.6). MRI examination showed meniscus third degree tear. The meniscus healing was evaluated by Barrett, MRI and arthroscopy. The knee joint function was evaluated by IKDC, Lysholm and Tegner. Results all the incisions healed in the first stage without joint infection and foreign body rejection. All patients were followed up for 26 ~ 63 months with an average of 42.8 months. BHT recurred in 2 patients within 1 year after operation. At the last follow-up, according to the criteria of Barrett et al, 72 cases of meniscus healed clinically, the clinical healing rate was 92.3%.IKDC score, Lysholm score and Tegner score were (81.5 鹵5.1), (86.9 鹵3.9), (6.2 鹵0.5), respectively, which were significantly different from those before operation (t = 14.598P0.000t = 18.478P0.000t = 3.362p 0.002). MRI). At the last follow-up, 56 cases were completely healed, 15 cases were partially healed, 7 cases were completely nonunion, the total healing rate was 91.0% (71 / 78), and the complete healing rate was 71.8% (56 / 78). The meniscus healed completely in 17 cases and partial healing in 4 cases. The total healing rate was 100% (21 / 21) and the complete healing rate was 81.0% (17 / 21). Conclusion the repair of medial meniscus BHT, by "encircling" suture under arthroscopy has the characteristics of firm suture, little influence on meniscus blood supply, and satisfactory intermediate curative effect.
【作者單位】： 深圳大學(xué)第一附屬醫(yī)院(深圳市第二人民醫(yī)院)運(yùn)動醫(yī)學(xué)科;
【基金】：廣東省科技計劃項目(2014A020212656、2014A030401017) 深圳市衛(wèi)生計生系統(tǒng)科研項目(201506025) 深圳市科技研發(fā)計劃項目(JCYJ20140414170821213、JCYJ20140414170821157)~~
【分類號】：R687.4

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