摘要
目的比较关节镜下双后内侧入路缝合钩缝合与Fast-Fix全内缝合治疗Ramp损伤的早期疗效。方法回顾分析2021年12月—2023年2月收治且符合选择标准的56例前交叉韧带断裂合并Ramp损伤患者临床资料。其中,采用关节镜下双后内侧入路缝合钩缝合28例(A组),关节镜下Fast-Fix全内缝合28例(B组)。两组患者年龄、性别、致伤原因、损伤类型、受伤至手术时间、损伤侧别、身体质量指数及术前膝关节Lysholm评分、疼痛视觉模拟评分(VAS)及Tegner评分等基线资料比较,差异均无统计学意义(P>0.05)。术后患者定期随访,参照Barrett临床愈合标准以及MRI评价标准评估Ramp区域临床及影像愈合情况;采用Lysholm评分、VAS评分及Tegner评分评价膝关节功能及疼痛程度,并与术前评价结果进行比较。结果两组术后切口均Ⅰ期愈合。患者均获随访,随访时间12~18个月,平均14.9个月。两组Mc Murray试验均为阴性。A、B组术后6个月临床愈合率分别为71.4%(20/28)、64.3%(18/28),12个月时分别为92.9%(26/28)、82.1%(23/28),组间差异均无统计学意义(χ^(2)=0.327,P=0.567;χ^(2)=0.469,P=0.225)。两组间术后各时间点Lysholm评分、VAS评分及Tegner评分比较,差异均无统计学意义(P>0.05);两组内术后各项评分均较术前改善,12个月时较6个月时进一步改善,差异均有统计学意义(P<0.05)。末次随访时,膝关节MRI复查示A组Ramp区域达完全愈合、部分愈合、未愈合分别有26例(92.9%)、2例(7.1%)、0例(0),B组为25例(89.3%)、1例(3.6%)、2例(7.1%),两组差异无统计学意义(Z=-0.530,P=0.596)。结论关节镜下双后内侧入路缝合钩缝合与Fast-Fix全内缝合治疗Ramp损伤均安全可靠,术后早期患者膝关节功能显著改善。
Objective To compare the short-term effectiveness of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions.Methods A clinical data of 56 patients with anterior cruciate ligament rupture combined with Ramp lesions,who met the selection criteria and admitted between December 2021 and February 2023,was retrospectively analyzed.The Ramp lesions were sutured using suture hook via double posteromedial approaches under arthroscopy in 28 cases(group A)and treated with Fast-Fix total internal suture under arthroscopy in 28 cases(group B).There was no significant difference in age,gender,cause of injury,type of injury,time from injury to operation,side of injury,body mass index,and preoperative Lysholm score,visual analogue scale(VAS)score,and Tegner score between the two groups(P>0.05).The patients were followed up regularly after operation,and the clinical and imaging healing of the Ramp lesion was evaluated according to the Barrett clinical healing standard and the MRI evaluation standard.Lysholm score,VAS score,and Tegner score were used to evaluate the function and pain degree of knee joint,and the results were compared with those before operation.Results The incisions of the two groups healed by first intention.All patients were followed up 12-18 months(mean,14.9 months).Postoperative McMurray tests were negative in both groups.The clinical healing rates of group A and group B were 71.4%(20/28)and 64.3%(18/28)at 6 months after operation,and 92.9%(26/28)and 82.1%(23/28)at 12 months after operation,respectively.The differences between the two groups was not significant(χ^(2)=0.327,P=0.567;χ^(2)=0.469,P=0.225).There was no significant difference in Lysholm score,VAS score,and Tegner score between the two groups at each time point after operation(P>0.05).The postoperative scores in the two groups significantly improved when compared with those before operation,and the scores at 12 months after operation further improved when compared with those at 6 months after operation,showing significant differences between the different time points in the two groups(P<0.05).At last follow-up,MRI examination of the knee joint showed that there were 26(92.9%),2(7.1%),and 0(0)cases of complete healing,partial healing,and nonunion in the Ramp lesion of group A,and 25(89.3%),1(3.6%),and 2(7.1%)cases in group B,respectively.There was no significant difference between the two groups(Z=−0.530,P=0.596).Conclusion Suture hook suture via double posteromedial approaches and Fast-Fix total internal suture under arthroscopy are safe and reliable in the treatment of Ramp lesion,and the knee joint function significantly improves after operation.
作者
程琛
秦海龙
孙学斌
CHENG Chen;QIN Hailong;SUN Xuebin(Department of Sports Medicine,First Affiliated Hospital of Xinjiang Medical University,Urumchi Xinjiang,830000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第6期716-722,共7页
Chinese Journal of Reparative and Reconstructive Surgery
