[1]张文桥,沈烈军,陈文锋.关节镜下经胫骨隧道带袢钢板固定与常规锚钉固定治疗内侧半月板后根部撕裂的比较研究[J].中医正骨,2021,33(11):24-30.
　ZHANG Wenqiao,SHEN Liejun,CHEN Wenfeng.A comparative study of arthroscopic Endobutton plate fixation through tibial tunnel versus conventional arthroscopic suture anchor fixation for treatment of medial meniscus posterior root tear[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(11):24-30.
点击复制

关节镜下经胫骨隧道带袢钢板固定与常规锚钉固定治疗内侧半月板后根部撕裂的比较研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年11期
页码:
24-30
栏目:
临床研究
出版日期:
2021-11-20

文章信息/Info

Title:
A comparative study of arthroscopic Endobutton plate fixation through tibial tunnel versus conventional arthroscopic suture anchor fixation for treatment of medial meniscus posterior root tear
作者:
张文桥; 沈烈军; 陈文锋
(舟山定海广华医院,浙江 舟山 316000)
Author(s):
ZHANG Wenqiao; SHEN Liejun; CHEN Wenfeng
Zhoushan Dinghai Guanghua Hospital,Zhoushan 316000,Zhejiang,China
关键词:
膝损伤;  半月板;  关节镜检查;  缝合锚;  带袢钢板;  胫骨隧道;  临床试验
Keywords:
knee injuries;  meniscus;  arthroscopy;  suture anchors;  endobutton plate;  tibial tunnel;  clinical trial
摘要:
目的:比较关节镜下经胫骨隧道带袢钢板固定与常规锚钉固定治疗内侧半月板后根部撕裂的临床疗效及安全性。方法:将106例内侧半月板后根部撕裂患者随机分为2组,每组53例,在关节镜辅助下分别采用经胫骨隧道带袢钢板固定(带袢钢板固定组)与常规锚钉固定(锚钉固定组)治疗。记录并比较2组患者的手术时间、术后下床时间、住院时间、膝关节主动屈伸范围、膝关节被动屈伸范围、膝关节文献委员会(International Knee Documentation Committee,IKDC)评分、Tegner膝关节活动水平评分、Lysholm膝关节评分及并发症发生情况。结果:①一般指标。2组患者的手术时间比较,差异无统计学意义[(110.52±18.64)min,(105.63±20.76)min,t=1.276,P=0.205]; 带袢钢板固定组患者的术后下床时间、住院时间均短于锚钉固定组[(24.35±6.87)h,(28.14±7.52)h,t=-2.709,P=0.008;(6.57±1.85)d,(7.76±1.94)d,t=-3.232,P=0.002]。②膝关节主动屈伸范围。术前2组患者膝关节主动屈伸范围比较,差异无统计学意义(45.92°±7.21°,44.52°±7.02°,t=1.013,P=0.313); 术后1年,带袢钢板固定组患者的膝关节主动屈伸范围大于锚钉固定组(102.74°±10.64°,95.76°±9.56°,t=3.553,P=0.001),2组患者膝关节主动屈伸范围均较术前增大(t=33.564,P=0.000; t=27.790,P=0.000)。③膝关节被动屈伸范围。术前2组患者膝关节被动屈伸范围比较,差异无统计学意义(50.21°±6.85°,50.55°±6.88°,t=-0.255,P=0.799); 术后1年,带袢钢板固定组患者的膝关节被动屈伸范围大于锚钉固定组(114.35°±11.58°,105.38°±10.25°,t=4.223,P=0.000),2组患者膝关节被动屈伸范围均较术前增大(t=36.116,P=0.000; t=32.268,P=0.000)。④IKDC评分。术前2组患者IKDC评分比较,差异无统计学意义[(31.58±4.29)分,(30.99±5.01)分,t=0.651,P=0.516]; 术后1年,带袢钢板固定组患者的IKDC评分高于锚钉固定组[(51.34±5.76)分,(45.76±7.52)分,t=4.289,P=0.000],2组患者IKDC评分均较术前增高(t=20.622,P=0.000; t=12.154,P=0.000)。⑤Tegner膝关节活动水平评分。术前2组患者Tegner膝关节活动水平评分比较,差异无统计学意义[(3.51±1.02)分,(3.42±1.05)分,t=0.448,P=0.655]; 术后1年,带袢钢板固定组患者的Tegner膝关节活动水平评分高于锚钉固定组[(7.38±1.85)分,(6.14±1.65)分,t=3.642,P=0.000],2组患者Tegner膝关节活动水平评分均较术前增高(t=13.778,P=0.000; t=11.976,P=0.000)。⑥Lysholm膝关节评分。术前2组患者Lysholm膝关节评分比较,差异无统计学意义[(50.92±7.05)分,(49.52±8.01)分,t=0.955,P=0.342]; 术后1年,带袢钢板固定组患者的Lysholm膝关节评分高于锚钉固定组[(85.64±7.38)分,(77.56±9.26)分,t=4.968,P=0.000],2组患者Lysholm膝关节评分均较术前增高(t=25.778,P=0.000; t=17.344,P=0.000)。⑦并发症。带袢钢板固定组术后出现切口深部感染4例、切口未一期愈合2例,锚钉固定组术后出现切口深部感染6例、切口未一期愈合3例; 2组患者并发症发生率比较,差异无统计学意义(χ2=0.699,P=0.403)。结论:关节镜下经胫骨隧道带袢钢板固定治疗内侧半月板后根部撕裂,与常规锚钉固定治疗相比,术后下床时间早、住院时间短、综合疗效好,膝关节屈伸范围大、关节功能好,但两者的手术时间及安全性相当。
Abstract:
Objective:To compare the clinical curative effects and safety of arthroscopic Endobutton plate(EP)fixation through tibial tunnel versus conventional arthroscopic suture anchors(SA)fixation for treatment of medial meniscus posterior root tear(MMPRT).Methods:One hundred and six MMPRT patients were enrolled in the study and were randomly divided into 2 groups,53 cases in each group,and they were treated with arthroscopic EP fixation through tibial tunnel(EP fixation group)and conventional arthroscopic SA fixation(SA fixation group)respectively.The operative time,bed rest time,hospital stay,active knee flexion-extension range of motion(ROM),passive knee flexion-extension ROM,International Knee Documentation Committee(IKDC)score,knee Tegner Activity scale(TAS)score,Lysholm knee score(LKS)and complications were recorded and compared between the 2 groups.Results:①There was no statistical difference in operative time between the 2 groups(110.52±18.64 vs 105.63±20.76 minutes,t=1.276,P=0.205).The bed rest time and hospital stay were shorter in EP fixation group compared to SA fixation group(24.35±6.87 vs 28.14±7.52 hours,t=-2.709,P=0.008; 6.57±1.85 vs 7.76±1.94 days,t=-3.232,P=0.002).②There was no statistical difference in active knee flexion-extension ROM between the 2 groups before the surgery(45.92±7.21 vs 44.52 ±7.02 degrees,t=1.013,P=0.313)...

参考文献/References:

[1] 黄竞敏,胡文晋.膝关节内侧半月板后根部撕裂的治疗进展[J].中华骨科杂志,2018,38(13):827-832.
[2] WANG P,ZHANG C Z,ZHANG D,et al.The imaging features of the meniscal roots on isotropic 3D MRI in young asymptomatic volunteers[J].Medicine(Baltimore),2018,97(18):e0624.
[3] 万浪,王小珍,闫亮,等.内侧半月板Ramp损伤的研究进展[J].中国矫形外科杂志,2018,26(18):1688-1691.
[4] 毕擎.重视半月板后根部撕裂[J].中国骨伤,2019,32(12):1077-1081.
[5] 汪睿,钱银锋,王紫玥,等.半月板根部撕裂与膝骨性关节炎严重度的关系[J].放射学实践,2019,34(6):664-667.
[6] 刘兆亮,孙雪冬,王军,等.膝内侧半月板与软骨退变损伤的相关性研究[J].精准医学杂志,2019,34(2):179-182.
[7] 黄竞敏,杨吉勇,吴疆,等.胫骨高位截骨联合内侧半月板后根部修复术的早期疗效及二次关节镜下探查结果[J].中华骨科杂志,2019,39(11):675-682.
[8] 黄晓斌,靳激扬.半月板后根部损伤的MRI诊断研究进展[J].国际医学放射学杂志,2017,40(4):419-423.
[9] 马秉正,张云峰,郭传友,等.小切口带线锚钉技术修复急性运动性跟腱断裂的临床疗效[J].中国医刊,2020,55(7):750-752.
[10] 刘昊,逸弘.半月板后根损伤研究进展[J].科技导报,2020,38(6):72-77.
[11] 姚彦斌,任民,李慎松,等.关节镜下缝线双排缝合交叉穿隧道固定前交叉韧带胫骨止点撕脱骨折[J].临床骨科杂志,2018,21(6):755-756.
[12] ERSOZ M,ERGUN S.Relationship between knee range of motion and Kellgren-Lawrence radiographic scores in knee osteoarthritis[J].Am J Phys Med Rehabil,2003,82(2):110-115.
[13] HEFTI F,MüLLER W,JAKOB R P,et al.Evaluation of knee ligament injuries with the IKDC form[J].Knee Surg Sports Traumatol Arthrosc,1993,1(3/4):226-234.
[14] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:182.
[15] BRIGGS K K,STEADMAN J R,HAY C J,et al.Lysholm score and Tegner activity level in individuals with normal knees[J].Am J Sports Med,2009,37(5):898-901.
[16] KENNEDY M I,STRAUSS M,LAPRADE R F.Injury of the meniscus root[J].Clin Sports Med,2020,39(1):57-68.
[17] GU X,SHAW L,GU K,et al.The meniscus-guided deposition of semiconducting polymers[J].Nat Commun,2018,9(1):534.
[18] 沈泌,付昌马,钱春生,等.内侧半月板损伤关节镜下治疗与髌内侧滑膜皱襞的相关性[J].中华全科医学,2020,18(5):763-765.
[19] SCHUSTER P,GE?EIN M,SCHLUMBERGER M,et al.Meniscus repairs can be saved in the event of postoperative septic arthritis[J].Knee Surg Sports Traumatol Arthrosc,2018,26(8):2289-2296.
[20] FLEMING E,TSUCHIYA K,BANERJEE D,et al.Local meniscus curvature during steady-state evaporation from micropillar arrays[J].ACS Appl Mater Interfaces,2020,12(38):43266-43272.
[21] 牟攀,牛小育,张春琪,等.半月板后根损伤诊治研究进展[J].中国中医骨伤科杂志,2019,27(12):84-88.
[22] 刘永红.关节镜半月板成形术联合功能锻炼对膝关节半月板损伤的疗效及关节功能影响研究[J].中国药物与临床,2019,19(7):1127-1129.
[23] 唐保明,李钊伟,杨爱荣,等.内外侧半月板后根部损伤有限元力学研究[J].中国矫形外科杂志,2019,27(22):2075-2079.
[24] 刘选泽,肖国庆,钟喜红,等.关节镜下钢丝引导缝合联合微骨折术修复膝关节外侧半月板后根部撕裂对膝关节本体感觉的影响[J].中国现代医学杂志,2021,31(4):26-30.
[25] 曾斌,吴旭东,黄小刚,等.关节镜下Healix带线锚钉经胫骨隧道缝合固定治疗半月板撕裂[J].中医正骨,2021,33(1):60-62.
[26] 彭晨健,袁滨,束昊,等.经胫骨隧道悬吊固定治疗半月板后根部撕脱损伤[J].中华关节外科杂志(电子版),2020,14(3):296-302.
[27] 杨江明,王伟.关节镜下经胫骨隧道拉线固定法治疗内侧半月板后根部撕裂的临床研究[J].中国药物与临床,2020,20(14):2344-2346.

相似文献/References:

[1]赵 丹.膝部骨折内固定术后的早期康复护理[J].中医正骨,2015,27(08):79.
[2]张蕾蕾,马向浩,张颖,等.功能锻炼联合中药薰洗和手法在前交叉韧带重建术后 康复治疗中的应用[J].中医正骨,2015,27(06):35.
[3]王东莉.缝合锚钉内固定治疗髌骨下极撕脱性骨折[J].中医正骨,2016,28(11):37.
[4]张辽,金甬,毛宇芳,等.髌旁小切口经髌股关节通道加压埋头空心钉结合缝线锚钉内固定治疗前交叉韧带胫骨止点撕脱骨折[J].中医正骨,2016,28(11):43.
[5]徐向峰,王庆东,金艳南,等.关节镜下可吸收螺钉内固定治疗髌骨骨软骨骨折[J].中医正骨,2016,28(12):65.
[6]李艺彬,朱勇,徐新强,等.关节镜下分型治疗儿童和青少年外侧盘状半月板损伤[J].中医正骨,2017,29(03):52.
[7]曾斌,吴旭东,黄小刚,等.腰托辅助膝关节外翻法在关节镜下内侧半月板后角成形术中的应用[J].中医正骨,2017,29(03):58.
[8]金永鑫.关节镜下半月板切除或缝合术治疗外侧半月板撕裂合并关节软骨损伤[J].中医正骨,2017,29(05):45.
[9]杨伟毅,潘建科,韩燕鸿,等.陈旧性前交叉韧带损伤诊治中需要注意的问题[J].中医正骨,2017,29(08):48.
[10]权松涛,蔡利涛,杨明路.单枚外排锚钉结合Orthocord缝合线线桥内固定治疗后交叉韧带胫骨止点撕脱骨折[J].中医正骨,2017,29(09):52.
[11]蒙剑德,夏贤生,赵小泉,等.功能锻炼联合中药薰蒸在膝关节半月板损伤关节镜下 成形术后康复治疗中的应用[J].中医正骨,2015,27(06):37.
[12]邵文飞.内服四妙散加减配合功能锻炼治疗膝关节半月板损伤[J].中医正骨,2015,27(06):39.
[13]张辉,庄万强,魏庆华,等.关节镜手术治疗前交叉韧带断裂合并半月板损伤[J].中医正骨,2018,30(07):56.
[14]曾斌,吴旭东,黄小刚,等.关节镜下Healix带线锚钉经胫骨隧道缝合固定治疗半月板撕裂[J].中医正骨,2021,33(01):60.
[15]刘辉,刘波,张鑫,等.终末伸膝肌电生物反馈训练在半月板损伤非手术治疗中的应用价值[J].中医正骨,2022,34(04):12.
　LIU Hui,LIU Bo,ZHANG Xin,et al.Applied values of terminal knee-extension electromyographic biofeedback training in nonsurgical treatment of meniscus injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(11):12.
[16]彭德强,王思雨,李健,等.关节镜手术联合玻璃酸钠注射治疗半月板损伤的Meta分析[J].中医正骨,2022,34(11):18.
　PENG Deqiang,WANG Siyu,LI Jian,et al.Arthroscopic surgery combined with hyaluronic acid injection for treatment of meniscus injury:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(11):18.
[17]陈钰祥.磁共振定量磁化率成像在半月板变性和半月板撕裂诊断中的应用价值[J].中医正骨,2022,34(09):33.
[18]陈帅,严海霞,张宏艺,等.关节镜下“川”字形三针全内垂直缝合技术治疗膝关节内侧半月板桶柄状撕裂[J].中医正骨,2023,35(03):73.
[19]袁祥生,周红星.关节镜下半月板成形缝合术与半月板部分切除术治疗单纯半月板撕裂伤的比较研究[J].中医正骨,2023,35(04):12.
　YUAN Xiangsheng,ZHOU Hongxing.A comparative study of arthroscopic meniscal suture versus partial meniscectomy in the treatment of simple meniscal laceration[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):12.
[20]叶子扬,叶秀云,胡艇.前交叉韧带断裂合并半月板撕裂的解剖学影响因素分析[J].中医正骨,2023,35(10):21.
　YE Ziyang,YE Xiuyun,HU Ting.Analysis of anatomic factors influencing anterior cruciate ligament rupture combined with meniscus tears[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):21.

备注/Memo

备注/Memo:
基金项目:舟山市卫生健康委员会医药卫生科技计划项目(2020YB05)
通讯作者:张文桥 E-mail:zhangwenqiaozs_zwq@163.com
更新日期/Last Update: 1900-01-01