桶柄样撕裂半月板缝合的临床效果及影像学评估
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北京大学第一医院

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Clinical effect and radiological assessment of the suturing of the Bucket Handle Tear of the Meniscus
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PEKING UNIVERSITY FIRST HOSPITAL

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    摘要:

    目的:通过分析半月板桶柄样撕裂行关节镜下半月板缝合患者的术前及术后的临床及MRI表现来评估桶柄样撕裂的半月板缝合术后的效果。 方法:随访25例半月板桶柄样撕裂行关节镜下缝合的患者,分析术前的受伤机制、主要症状、体检情况及Lysholm评分及IKDC评分及MRI资料,术后半年的膝关节情况及Lysholm评分和IKDC评分及MRI资料,通过分析术后的临床效果及Lysholm评分和IKDC评分及MRI上的表现来对半月板缝合的治疗效果做出评估。 结果:25例患者中,男21例,女4例,内侧半月板损伤21例,外侧半月板损伤4例,合并前交叉韧带断裂18例,未合并前交叉韧带断裂7例。撕裂部位17例位于红区,8例位于红白区,后角撕裂用全内缝合,体部撕裂用由内到外方法缝合,前角用由外到内方法缝合。Lysholm评分由术前的23±5分提高到术后88±7分,IKDC膝关节功能主观评分由术前12±5提高到术后89±2分。25例患者中有2例患者术后出现症状再次行关节镜手术将未愈合的撕裂部分半月板切除。MRI复查见半月板撕裂处T2质子相信号较术前明显降低,未见明显新发撕裂,半月板愈合良好。结论:半月板桶柄样撕裂经关节镜下缝合修复术后临床效果满意,合并前交叉韧带损伤者同时进行前交叉韧带重建和半月板缝合能取得较好的临床效果和较低的失败率,单纯半月板缝合效果较差。 关键词:桶柄样撕裂、半月板损伤、半月板缝合

    Abstract:

    Abstract Objective : Assess the effect of the suturing of the Bucket Handle Tear of the Meniscus through analysis the clinical effect and radiological manisfestration pre and post the operation of the suturing the meniscus. Method: Review and follow up the twenty-five patients diagnosed as bucket handle tear of the meniscus, analysis the model of the injury, main complaint, the result of the physical examination, the assessment of Lysholm and IKDC and the file of MRI pre-operation and half a year post-operation. Make the assessment of the effect of suturing the bucket handle tear meniscus through analysising the clinical effect and the assessment of Lysholm and IKDC and the MRI files. Result: There are twenty five patients including in this study, twenty one male patients and four female patients are included. There are twenty one patients torn the medial meniscus and four cases torn the lateral meniscus. There are eighteen patients complied with rupture of the anterior cruciate ligament. As to the location of the tear, seventeen are at red to red zone the other eight are at red to white zone. To suture the torn meniscus, we suture the posterior corner of the bucket tunnel torn meniscus using in to in method, suture the body part of the meniscus using in to out method, suture the anterior corner of the meniscus using out to in method. The Lysholm score is improved to 88±7 which is 23±5 before the operation. The IKDC subjective score is improved to 89±2 which was 12±5 before the operation. The MRI shows that the signal of the tear of the meniscus is weaker than what it was before the operation, there are not any new tear of the meniscus happened. The effect of the healing of the meniscus is excellent. Conclusion: The clinical outcome of arthroscopic suturing the bucket handled tear of the meniscusis satisfied, and those received meniscus suturing and anterior cruciate ligament reconstruction as well had showed better clinical outcome and high healing rate of the meniscus. Those receiving meniscus suturing only had showed worse clinical outcome, the healing rate of the meniscus was low. Key words: bucket handled tear, injury of the meniscus, suturing of the meniscus.

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  • 收稿日期:2019-03-14
  • 最后修改日期:2019-05-18
  • 录用日期:2019-05-22
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