摘要
目的探讨外侧半月板后根部(lateral meniscus posterior root,LMPR)修复联合前十字韧带(anterior cruciate ligament,ACL)重建术治疗合并LMPR慢性撕脱损伤的ACL撕裂的临床疗效。方法回顾性分析2015年7月至2017年6月LMPR慢性撕脱合并ACL撕裂患者33例,男30例,女3例;年龄(27.7±7.5)岁(范围17~45岁)。由同一术者施行胫骨隧道拉出式LMPR修复自体腘绳肌腱ACL解剖单束重建术,随访2年以上。根据二次关节镜下探查结果评估半月板愈合,根据Lysholm和Tegner评分评估膝关节主观功能,根据麻醉下KT-1000侧侧差值和轴移试验评估膝关节客观稳定性,根据矢状面MRI上胫骨前移距离评估股骨-胫骨静态位置关系。以术前胫骨前移距离进行分组,前移至少6 mm者(前移阳性组)18例,前移小于6 mm者(前移阴性组)15例,比较术前及术后2年两组患者胫骨前移距离及其降低程度的差异。结果所有患者随访(27.5±4.0)个月(范围24~39个月)。LMPR完全愈合23例(70%)、部分愈合9例(27%)、不愈合1例(3%)。Lysholm评分由(60.4±13.6)分提高至术后1年的(82.7±11.1)分、术后2年的(91.4±9.1)分(F=155.996,P<0.001);Tegner评分由3(2,5)分[M(P25,P75)]提高至术后1年的4(3,5)分、术后2年的6(4,6)分(χ^2=47.791,P<0.001)。KT-1000侧侧差值由(9.1±3.3)mm降低至(2.0±1.7)mm(t=11.197,P<0.001);轴移试验由Ⅰ度10例、Ⅱ度20例、Ⅲ度3例改善至正常30例、Ⅰ度3例(U=5.161,P<0.001)。胫骨前移距离由(5.7±3.9)mm减少至(3.5±3.2)mm(t=3.530,P=0.001)。术后2年,前移阳性组的胫骨前移由(8.7±1.8)mm下降至(5.0±3.3)mm(t=4.765,P<0.001),前移阴性组的胫骨前移与术前比较差异无统计学意义(t=0.400,P=0.695)。前移阳性组胫骨前移下降幅度为(3.7±3.3)mm,大于前移阴性组的(0.3±2.8)mm(t=3.115,P=0.004)。结论胫骨隧道拉出式LMPR修复联合ACL重建术治疗合并LMPR慢性撕脱损伤的ACL撕裂,术后2年半月板愈合率高;膝关节主观功能及客观稳定性提高,能够有效改善术前胫骨前移≥6 mm患者的股骨-胫骨静态位置关系。
Objective To evaluate the clinical,radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root(LMPR)avulsion combined with anterior cruciate ligament(ACL)reconstruction.Methods From July 2015 to June 2017,a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed.There were 30 males and 3 females with an average age of 27.7±7.5 years(range 17-45 years)and a mean BMI of 25.2±3.7 kg/m2(range 19.4-36.7 kg/m2).All patients were available for at least two years of follow-up.A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus.Subjective knee function was assessed through Lysholm and Tegner scores.Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference(SSD)and pivot shift test under anesthesia.The tibiofemoral relationship was evaluated by anterior tibial subluxation(ATS)measured on axial MRI.Between patients with preoperative ATS≥6 mm(18 patients in the ATS positive group)and<6 mm(15 patients in the ATS negative group),the postoperative ATS and the reduction of ATS was also compared.Results After a mean follow-up of 27.5±4.0 months(range 24-39 months),the LMPR avulsion completely healed in 23(70%)cases,partially healed in 9(27%)cases,failed to heal in 1(3%)case on second-look arthroscopy.The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively(F=155.996,P<0.001).The Tegner score was increased from 3(2,5)to 4(3,5)at 1 year and 6(4,6)at 2 years postoperatively(χ2=47.791,P<0.001).The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm(t=11.197,P<0.001).The result of pivot shift test was also improved(10 grade I,20 grade II,3 grade III,preoperatively vs 30 grade 0,3 grade I,postoperatively,U=5.161,P<0.001).The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm(t=3.530,P=0.001).However,there was no statistically significant decrease in the ATS of the ATS negative group(t=0.400,P=0.695).The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm(t=4.765,P<0.001),and the ATS reduction of the ATS positive group was greater than that of the ATS negative group(3.7±3.3 mm vs 0.3±2.8 mm,t=3.115,P=0.004).Conclusion In patients undergoing ACL reconstruction,the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97%with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.
作者
郑峒
冯华
张辉
宋关阳
李岳
张志军
倪乾坤
曹晏维
冯峥
Zheng Tong;Feng Hua;Zhang Hui;Song Guanyang;Li Yue;Zhang Zhijun;Ni Qiankun;Cao Yanwei;Feng Zheng(Sports Medicine Service,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第7期424-432,共9页
Chinese Journal of Orthopaedics
基金
北京市医院管理局"登峰"计划(DFL20180402)
国家自然科学基金(81572153)
北京市优秀人才-青年骨干项目(2018000021469G227)。
关键词
前交叉韧带重建
半月板
胫骨
治疗结果
关节镜检查
Anterior cruciate ligament reconstruction
Menisci
tibial
Treatment outcome
Arthroscopy
