经胫骨隧道悬吊固定治疗半月板后根部撕脱损伤

doi:10.3877/cma.j.issn.1674-134X.2020.03.007

目的

观察关节镜下经胫骨隧道拉出悬吊固定技术治疗半月板后根部撕脱损伤的临床效果。

方法

自2014年9月至2017年12月，对20例前交叉韧带损伤伴随半月板后根部撕脱损伤的患者，在前交叉韧带单束重建的同时采用关节镜下经胫骨隧道拉出悬吊固定技术修复半月板后根部撕脱损伤。纳入前交叉韧带损伤伴随半月板后根部撕脱损伤的患者，排除术前下肢力线异常者及合并软骨损伤者。术前和术后1年时通过Lysholm评分和Tegner评分对患者膝关节功能进行评估，并通过磁共振(MR)观察术后半月板后根部撕脱损伤愈合情况。定量资料比较采用配对样本t检验。

结果

所有患者均进行超过1年的随访，患者术后1年随访时Lysholm评分及Tegner评分较术前均有显著提高(t＝7.98、5.55，均为P<0.05)；且MR观察未发现半月板后根部再撕裂或半月板体部外凸。

结论

关节镜下经胫骨隧道拉出悬吊固定技术可将半月板后根部撕脱复位并稳定固定于其解剖止点区域，从而维持半月板的环状结构以期最大程度恢复膝关节的功能，短期临床效果良好。

关键词: 损伤，半月板, 关节镜检查, 膝关节

Objective

To evaluate the clinical outcome of arthroscopic trans-tibia pull-out suepensory technique in the treatment of meniscus posterior horn root tear.

Methods

From September 2014 to December 2017, twenty patients with both anterior cruciate ligament injury and meniscus posterior horn root tear were treated with single bundle anterior cruciate ligament reconstruction and a trans-tibial pull-out suspensory meniscal repair technique. The cases combined with cartilage injury and abnormal mechanical line of lower limb were excluded. The knee function was evaluated by Lysholm score and Tegner score before operation and one year after operation, the healing of meniscus posterior horn root was observed by magnetic resonance (MR). Paired-t test was used for comparing quantitative data.

Results

All the patients had a more than one year follow-up. The Lysholm score and Tegner score of patients one year after operation are significantly higher than those before operation (t=7.98, 5.55 respectively, P<0.05), and MR showed no evidence of meniscal retear and extrusion.

Conclusion

Trans-tibial pull-out suspensory technique can anatomically fix the posterior horn root avulsion of meniscus, it can also restore the hoop of the meniscus, significantly improved the knee function, and achieve good short-term clinical outcome.

Key words: Injuries, meniscus, Arthroscopy, Knee

图1 关节镜下内侧半月板后根部胫骨隧道拉出悬吊固定技术。图A为探查发现的内侧半月板后根部撕脱损伤，红箭头所示；图B为前叉定位弓在内侧半月板后根部解剖附着处建立胫骨隧道；图C为缝合钩穿出半月板放出PDS(聚对二氧环己酮)线；图D为1号爱惜邦通过PDS线引入；图E为从胫骨隧道内进入抓钳抓取1号爱惜邦缝线游离端；图F为固定后的内侧半月板后根部，红箭头所示；MMPR(内侧半月板后根部)

图2 关节镜下外侧半月板后根部胫骨隧道拉出悬吊固定技术缝合。图A为探查发现的外侧半月板后根部撕脱损伤，红箭头所示；图B为前叉定位弓在外侧半月板后根部解剖附着处建立胫骨隧道；图C为缝合钩穿出半月板放出PDS(聚对二氧环已酮)线；图D为1号爱惜邦通过PDS线引入；图E为从胫骨隧道内进入抓钳抓取1号爱惜邦缝线游离端；图F为固定后的外侧半月板后根部，红箭头所示；LMPR(外侧半月板后根部)

表1 功能评分情况[n＝20，(±s)]

时间	Lysholm评分	Tegner评分
术前	59.6±18.6	4.6±1.5
术后	81.8±6.4	7.6±1.8
t值	7.98	5.55
P值	<0.01	<0.01

表1 功能评分情况[n＝20，(±s)]

时间	Lysholm评分	Tegner评分
术前	59.6±18.6	4.6±1.5
术后	81.8±6.4	7.6±1.8
t值	7.98	5.55
P值	<0.01	<0.01

图3 LMPHRT(外侧半月板后根部撕脱)合并ACL(前交叉韧带)损伤术前膝关节MR图像。图A为膝关节冠状位MRI，红箭头示LMPHRT；图B为膝关节矢状位MRI，红箭头示ACL损伤

图4 经胫骨隧道pull-out技术修复LMPHRT(外侧半月板后根部撕脱)同时行ACL(前交叉韧带)重建术后MR影像。图A为膝关节冠状位MRI，红箭头示半月板胫骨隧道情况，内口位于外侧半月板根部；图B为膝关节矢状位MRI，黄箭头示ACL重建后胫骨隧道，红箭头示半月板胫骨隧道情况，内口位于外侧半月板根部

图5 MMPHRT(内侧半月板后根部撕脱)合并ACL(前交叉韧带)损伤术前膝关节MR图像。图A为膝关节冠状位MRI，红箭头示MMPHRT；图B为膝关节矢状位MRI，红箭头示ACL损伤

图6 经胫骨隧道拉出悬吊技术修复MMPHRT(内侧半月板后根部撕脱)＋ACL(前交叉韧带)重建术后影像。图中红箭头示半月板胫骨隧道位置，黄箭头示ACL重建后胫骨隧道位置。图A为术后膝关节正位X线片；图B为术后1年膝关节冠状位MRI，示MMPHR愈合，半月板信号连续，未见T2信号；图C为术后1年膝关节矢状位MRI，示半月板胫骨隧道内口位于内侧半月板根部，骨隧道愈合，黄箭头示ACL重建后胫骨隧道位置良好，未见骨隧道扩大

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Clinical outcomes of meniscus posterior root horn repair using trans-tibial pull-out suspensory technique

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Clinical outcomes of meniscus posterior root horn repair using trans-tibial pull-out suspensory technique