[1]代朋乙,张智敏,王战朝,等.内侧副韧带拉花松解在膝关节镜手术治疗合并膝关节内侧间室狭窄的内侧半月板后角损伤中的应用[J].中医正骨,2021,33(08):66-70.
　DAI Pengyi,ZHANG Zhimin,WANG Zhanchao,et al.Application of medial collateral ligament pie-crusting release in knee arthroscopic surgery for treatment of medial meniscus posterior horns injuries combined with knee medial compartment stenosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):66-70.
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内侧副韧带拉花松解在膝关节镜手术治疗合并膝关节内侧间室狭窄的内侧半月板后角损伤中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年08期
页码:
66-70
栏目:
临床报道
出版日期:
2021-08-20

文章信息/Info

Title:
Application of medial collateral ligament pie-crusting release in knee arthroscopic surgery for treatment of medial meniscus posterior horns injuries combined with knee medial compartment stenosis
作者:
代朋乙; 张智敏; 王战朝; 赵晓非
(河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002)
Author(s):
DAI Pengyi; ZHANG Zhimin; WANG Zhanchao; ZHAO Xiaofei
关键词:
半月板; 胫骨;  关节镜检查;  内侧副韧带; 膝
摘要:
目的:探讨内侧副韧带(medial collateral ligament,MCL)拉花松解在膝关节镜手术治疗合并膝关节内侧间室狭窄的内侧半月板后角损伤中的应用价值。方法:2015年1月至2017年7月收治33例经临床和MRI检查诊断为膝关节内侧半月板后角损伤的患者。男20例,女13例。年龄14～50岁,中位数28岁。均为单侧损伤,左侧15例、右侧18例。新鲜损伤23例、陈旧损伤10例,陈旧损伤者患侧股四头肌均有不同程度萎缩。均拟行关节镜下探查修复术,受伤至手术时间6 h至6个月,中位数63 d。关节镜下探查确认内侧半月板后角撕裂且具备缝合条件,但均合并膝关节内侧间室狭窄。维持膝关节外翻位,先在膝关节镜下采用腰椎穿刺套管针对内侧半月板后角附着部位周围的MCL进行拉花松解,然后在腰椎穿刺套管针辅助下以细钢丝引导可吸收缝线缝合内侧半月板后角损伤部位。采用Lysholm膝关节功能评分标准、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节主观功能评分标准以及膝部疼痛视觉模拟量表(visual analogue scale,VAS)评估临床疗效,采用MRI评估内侧半月板损伤愈合情况,并观察治疗及随访过程中并发症的发生情况。结果:经关节镜检查,均确诊为合并膝关节内侧间室狭窄的内侧半月板后角损伤,其中纵形撕裂16例、水平撕裂10例、横形撕裂4例、混合撕裂3例。所有患者均获随访,随访时间24～28个月,中位数25个月。切口均甲级愈合,均未发生神经血管损伤。术后6个月随访时,MRI检查结果显示30例患者的内侧半月板后角损伤愈合,其中0级13例、I级10例、Ⅱ级7例,其余3例损伤处信号为Ⅲ级,但均无相应临床症状和体征。末次随访时所有患者均恢复正常生活及运动,患膝屈曲0°、30°外翻应力试验均为阴性。患者术前、术后1个月、术后3个月、术后6个月及末次随访时的Lysholm评分、IKDC评分及膝部疼痛VAS评分总体比较,差异均有统计学意义[Lysholm评分:(50.13±6.81)分,(62.75±6.36)分,(89.25±5.69)分,(92.16±4.14)分,(94.35±3.65)分,F=35.646,P=0.000; IKDC评分:(49.06±6.31)分,(61.96±6.15)分,(88.75±5.23)分,(91.85±4.38)分,(93.75±3.71)分,F=37.522,P=0.000; 膝部疼痛VAS评分:(8.76±1.61)分,(4.51±1.86)分,(2.89±1.88)分,(2.56±1.69)分,(2.38±1.56)分,F=9.934,P=0.003]。术后1个月、3个月、6个月及末次随访时的Lysholm评分、IKDC评分均高于术前(Lysholm评分:P=0.021,P=0.000,P=0.000,P=0.000; IKDC 评分:P=0.018,P=0.000,P=0.000,P=0.000); 术后3个月、6个月及末次随访时的Lysholm评分、IKDC评分均高于术后1个月(Lysholm评分:P=0.000,P=0.000; IKDC评分:P=0.000,P=0.000); 术后3个月、6个月及末次随访时的Lysholm评分、IKDC评分两两比较,差异均无统计学意义。术后1个月、3个月、6个月及末次随访时的膝部疼痛VAS评分均低于术前(P=0.007,P=0.000,P=0.000,P=0.000); 术后3个月、6个月及末次随访时的膝部疼痛VAS评分均低于术后1个月(P=0.045,P=0.033,P=0.014); 术后3个月、6个月及末次随访时的膝部疼痛VAS评分两两比较,差异均无统计学意义。结论:在采用膝关节镜手术治疗合并膝关节内侧间室狭窄的内侧半月板后角损伤时,进行MCL拉花松解能增大膝关节内侧间隙,改善手术视野,术后患者膝关节疼痛减轻、功能恢复良好,并发症少。

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备注/Memo

备注/Memo:
通讯作者:张智敏 E-mail:zhangzhimin@163.com
更新日期/Last Update: 1900-01-01