摘要
目的研究关节镜下边对边全内缝合LaPrade 2B、2C型外侧半月板后根损伤合并前交叉韧带重建的短期疗效。方法回顾性分析2019年8月—2021年3月新疆医科大学第一附属医院骨科中心运动医学科诊断为前交叉韧带断裂合并外侧半月板后根放射状撕裂的37例患者,男性32例,女性5例;年龄17~45岁,平均28.1岁。均接受关节镜下边对边全内缝合外侧半月板后根及前交叉韧带重建术。均接受至少1年的随访,平均随访时间17.5个月。记录术前、末次随访时的Lachman试验,术前、术中、末次随访时轴移试验阳性率,术前和末次随访时的Lysholm膝关节评分,国际膝关节文献委员会(IKDC)评分,VAS,末次随访时半月板外凸、临床愈合、MRI愈合及二次关节镜下检查的愈合情况。结果本组37例患者末次随访时,36例患者达到了临床愈合,临床愈合率为97.3%;34例患者术后半月板MRI图像显示愈合,愈合率为91.9%;21例患者行二次关节镜探查,镜下愈合率为100.0%。末次随访时的IKDC评分、Lysholm膝关节评分、VAS较术前显著改善,差异均有统计学意义(P<0.05);术前轴移试验、Lachman试验均为阳性,阳性率为100.0%,术中半月板缝合后即刻的轴移试验均为阴性,末次随访时Lachman试验均为阴性。术后膝关节MRI冠状位外侧半月板外凸最小为0.2 mm,最大为1.4 mm,平均0.82 mm,其中外凸>1 mm的有10例,占27.0%,平均>0.2 mm。结论关节镜下重建前交叉韧带及边对边全内缝合外侧半月板后根LaPrade 2B、2C型新鲜的半月板损伤,术后短期内可以完全达到临床愈合,且可以恢复半月板的环形张力及生物力学功能,不会造成明显的半月板外凸。
Objective To study the short-term effect of arthroscopic side-to-side all-inside suture of Laprade type 2B and 2C posterior root injuries of the lateral meniscus combined with anterior cruciate ligament(ACL)reconstruction.Methods A retrospective analysis was conducted on 37 patients diagnosed with ACL rupture combined with radial tear of the posterior root of the lateral meniscus at the First Affiliated Hospital of Xinjiang Medical University from Aug.2019 to Mar.2021.Among the patients,32 were male and 5 were female,with the ages ranging from 17 to 45(mean 28.1)years.All patients underwent arthroscopic side-to-side all-inside suture of the posterior root of the lateral meniscus and ACL reconstruction.Patients were followed up for at least one year,with an average follow-up period of 17.5 months.The Lachman test results,positive rates of pivot shift tests before&during surgery and at the last follow-up,knee joint scores like Lysholm score and International Knee Documentation Committee(IKDC)score,VAS,meniscus extrusion at the last follow-up,clinical healing,MRI healing and healing conditions during the second arthroscopic examination were recorded.Results At the last follow-up of the 37 patients,36 achieved clinical healing,with a clinical healing rate of 97.3%;34 patients showed healed meniscus on MRI images,with a healing rate of 91.9%;21 patients underwent secondary arthroscopic exploration,of whom the arthroscopic healing rate was 100.0%.The IKDC knee joint scores,Lysholm scores and pain assessed by VAS at the last follow-up were significantly improved compared with those before surgery(P<0.05).The anterior drawer test and Lachman test were both positive before surgery,with a positive rate of 100.0%.The intraoperative anterior drawer test turned negative immediately after meniscus suture,and all the Lachman tests showed negative results at the last follow-up.The lateral meniscus extrusion on coronal MRI of the knee joint after the operation was minimally 0.2 mm and maximally 1.4 mm,0.82 mm on average.Among them,10 patients had an extrusion>1 mm,accounting for 27.0%.The average extrusion was 0.2 mm.Conclusion Arthroscopic ACL reconstruction and side-to-side all-inside suture of the posterior root for lateral meniscus Laprade types 2B and 2C fresh meniscus injuries can achieve full clinical healing,and restore the circular tension and biomechanical function of the meniscus,without causing obvious meniscus extrusion.
作者
秦海龙
张克远
Qin Hailong;Zhang Keyuan(Sports Medicine Department,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
出处
《创伤外科杂志》
2025年第5期359-363,共5页
Journal of Traumatic Surgery
关键词
外侧半月板后根损伤
前交叉韧带损伤
边对边缝合
半月板外凸
Posterior lateral meniscus root injury
Anterior cruciate ligament injury
Side to side suture
Meniscus extrusion
