经胫骨隧道外侧半月板后角缝合固定的疗效观察

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背景:外侧半月板后角损伤在临床中具有较高发生率,修复方法包括关节镜下由内向外缝合、由外向内缝合和完全关节内缝合,但均较难达到解剖复位.随着对其生物力学研究深入,外侧半月板后角的解剖复位更有利于其功能恢复.目的:评价采用经胫骨隧道治疗外侧半月板后角损伤的疗效.方法:2012年6月至2014年6月本院治疗12例外侧半月板后角撕裂患者,术前Lysholm评分(48.58±6.63)分,按Ikeuchi膝关节评价等级,12例均为差.根据术中外侧半月板后角损伤情况,用肩关节镜器械包中带线弯钩缝合,并于损伤止点处行胫骨隧道钻孔,缝线经胫骨隧道穿出在胫骨外固定,观察术后膝关节功能恢复情况.结果:患者术后无感染、血管神经损伤,关节活动受限等并发症的发生,功能良好.术后12个月随访显示Lysholm评分上升至(90.42±2.64)分,较术前明显改善(P<0.05).Ikeuchi膝关节评价等级,优10例,良1例,可1例,优良率91.7%(11/12).结论:经胫骨隧道固定外侧半月板后角,符合解剖位置,是一种良好的固定方式.“,”Background:There is a high incidence of injury of the posterior horn of the lateral meniscus. The repair tech-niques include inside-out suture, out-inside suture, and all inside suture under the arthroscope, but they are hard to provide anatomic reduction. With the development of biomechanics, the anatomic reduction is more conducive to the function re-sumption. Objective:To evaluate the curative results of arthroscopy through tibial tunnel for the treatment of posterior horn of the lateral meniscus tears. Methods:Twelve patients with the lateral meniscus posterior horn tears treated in our hospital from June 2012 to June 2014 were enrolled in this study. Preoperative Lysholm score was (48.58 ± 6.63). According to the grading system of Ikeuchi, all of them were poor. During the operation, we used the suture hook from the shoulder arthrosco-py instruments, and drilled the tibial tunnel in the posterior horn insertion zone, then pulled out the suture through the tibial tunnel with external fixation. Lysholm score and Ikeuchi grade were evaluated after treatment. Results:The function of the knee recovered well, no complications such as infection, vascular or nerve injury, limited joint mobility occurred. The Lysholm score reached to 90.42 ± 2.64 at 12 months after surgery, which was significantly higher than preoperative one (P<0.05). The outcome of Ikeuchi grade system was excellent in 10 patients, good in one and fair in another one, and the rate of excellent and good cases was 91.7%(11/12). Conclusions:The fixation of posterior horn of the lateral meniscus through the tibial tunnel can be stable and guarantee the anatomical position. It is a good surgical option for meniscus posterior horn tears.
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