关节镜下修补半月板桶柄样撕裂的临床疗效分析

目的 探讨关节镜下修补半月板桶柄样撕裂的临床疗效.方法 关节镜下对61例63个桶柄样撕裂的半月板行修补手术,男38例,女23例;年龄16～47岁,平均27岁.内侧半月板后体部至前体部区域撕裂及外侧半月板胴肌腱前方区域撕裂采用标准的白内向外缝合技术;内侧半月板后角区域撕裂采用经两个后内侧入路的全关节内缝合技术;外侧半月板后角区域撕裂采用经前方关节镜入路的全关节内缝合技术.结果 61例63个半月板随访时间24～66个月,平均38个月.其中51例(53个半月板)行二次关节镜检.44个半月板(83%)完全愈合,5个半月板(9.4%)部分愈合,4个半月板(7.5%)不愈合.61例患者均进行临床评估,其中53例(87%)无临床症状,4例(6.5%)有部分临床症状,4例(6.5%)绞锁复发.总体评估:失效率为7.9%(5/63),成功率92.1%(包括完全愈合、部分愈合、无临床症状及部分临床症状者).结论 对于发生在红一红区或红一白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,可以获得约92%的成功率.

Clinical results of arthroscopic repair for bucket-handle meniscus tears

Objective To analyse the clinical results of arthroscopic repair for bucket-handle meniscus tears.Methods From May 2002 to November 2005,61 patients with bucket-handle meniscus tears underwent arthroscopie repair,including 38 males and 23 females,with the mean age of 27 years (range,16-47 years).The arthroscopic repair technique included inside-out and all-inside suture repair,in addition with meniscus fixat or,according to the meniscus injury zones.The anterior and mid 1/3 portion of the medial meniscus and anterior popliteal tendon part of lateral meniscus were repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement.The most posterior portion of medial meniscus and posterior popliteal tendon portion of lateral meniscus were repaired using all-inside suture technique,with two posterior portals for medial side and trans-anteromedial portal for lateral side respectively.Results Sixty-one patients with 63 menisci were followed up for 24 to 66 months,average 38 months.Among them,53 menisci in 51 patients (83.6%) were assessed by second-look arthroscopy comfirming that 44 repairs (83%) completely healed,5 (9.4%) partially healed,4(7.5% )failed and proceeded with meniscectomy.All patients were available for clinical evaluation.Fifty-three of 61 patients (87%) were asymptomatic,4(6.5%) patients were partial asymptomatic and 4 (6.5%) had recurrent locking showing failure.Overall,five of 63 repairs failed (7.9%),58 succeed(92.1%),including complete healing,partial healing,asymptomatic and partial asymptomatic patients.Conclusion For large bucket-handle meniscus tears in-volving red-red and red-white zones,reliable arthroscopic hybrid suture technique,provides stable suturestrength along the whole length of injuried region and consequently achieve improved subjective and objec-tive clinical outcomes with 92% success rate.