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[1]代朋乙,張智敏,王戰(zhàn)朝,等.內(nèi)側(cè)副韌帶拉花松解在膝關(guān)節(jié)鏡手術(shù)治療合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄的內(nèi)側(cè)半月板后角損傷中的應(yīng)用[J].中醫(yī)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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內(nèi)側(cè)副韌帶拉花松解在膝關(guān)節(jié)鏡手術(shù)治療合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄的內(nèi)側(cè)半月板后角損傷中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年08期
頁碼:
66-70
欄目:
臨床報道
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; 張智敏; 王戰(zhàn)朝; 趙曉非
(河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002)
Author(s):
DAI Pengyi; ZHANG Zhimin; WANG Zhanchao; ZHAO Xiaofei
關(guān)鍵詞:
半月板; 脛骨;  關(guān)節(jié)鏡檢查;  內(nèi)側(cè)副韌帶; 膝
摘要:
目的:探討內(nèi)側(cè)副韌帶(medial collateral ligament,MCL)拉花松解在膝關(guān)節(jié)鏡手術(shù)治療合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄的內(nèi)側(cè)半月板后角損傷中的應(yīng)用價值。方法:2015年1月至2017年7月收治33例經(jīng)臨床和MRI檢查診斷為膝關(guān)節(jié)內(nèi)側(cè)半月板后角損傷的患者。男20例,女13例。年齡14～50歲,中位數(shù)28歲。均為單側(cè)損傷,左側(cè)15例、右側(cè)18例。新鮮損傷23例、陳舊損傷10例,陳舊損傷者患側(cè)股四頭肌均有不同程度萎縮。均擬行關(guān)節(jié)鏡下探查修復(fù)術(shù),受傷至手術(shù)時間6 h至6個月,中位數(shù)63 d。關(guān)節(jié)鏡下探查確認內(nèi)側(cè)半月板后角撕裂且具備縫合條件,但均合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄。維持膝關(guān)節(jié)外翻位,先在膝關(guān)節(jié)鏡下采用腰椎穿刺套管針對內(nèi)側(cè)半月板后角附著部位周圍的MCL進行拉花松解,然后在腰椎穿刺套管針輔助下以細鋼絲引導(dǎo)可吸收縫線縫合內(nèi)側(cè)半月板后角損傷部位。采用Lysholm膝關(guān)節(jié)功能評分標準、國際膝關(guān)節(jié)文獻委員會(International Knee Documentation Committee,IKDC)膝關(guān)節(jié)主觀功能評分標準以及膝部疼痛視覺模擬量表(visual analogue scale,VAS)評估臨床療效,采用MRI評估內(nèi)側(cè)半月板損傷愈合情況,并觀察治療及隨訪過程中并發(fā)癥的發(fā)生情況。結(jié)果:經(jīng)關(guān)節(jié)鏡檢查,均確診為合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄的內(nèi)側(cè)半月板后角損傷,其中縱形撕裂16例、水平撕裂10例、橫形撕裂4例、混合撕裂3例。所有患者均獲隨訪,隨訪時間24～28個月,中位數(shù)25個月。切口均甲級愈合,均未發(fā)生神經(jīng)血管損傷。術(shù)后6個月隨訪時,MRI檢查結(jié)果顯示30例患者的內(nèi)側(cè)半月板后角損傷愈合,其中0級13例、I級10例、Ⅱ級7例,其余3例損傷處信號為Ⅲ級,但均無相應(yīng)臨床癥狀和體征。末次隨訪時所有患者均恢復(fù)正常生活及運動,患膝屈曲0°、30°外翻應(yīng)力試驗均為陰性。患者術(shù)前、術(shù)后1個月、術(shù)后3個月、術(shù)后6個月及末次隨訪時的Lysholm評分、IKDC評分及膝部疼痛VAS評分總體比較,差異均有統(tǒng)計學(xué)意義[Lysholm評分:(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評分:(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評分:(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]。術(shù)后1個月、3個月、6個月及末次隨訪時的Lysholm評分、IKDC評分均高于術(shù)前(Lysholm評分:P=0.021,P=0.000,P=0.000,P=0.000; IKDC 評分:P=0.018,P=0.000,P=0.000,P=0.000); 術(shù)后3個月、6個月及末次隨訪時的Lysholm評分、IKDC評分均高于術(shù)后1個月(Lysholm評分:P=0.000,P=0.000; IKDC評分:P=0.000,P=0.000); 術(shù)后3個月、6個月及末次隨訪時的Lysholm評分、IKDC評分兩兩比較,差異均無統(tǒng)計學(xué)意義。術(shù)后1個月、3個月、6個月及末次隨訪時的膝部疼痛VAS評分均低于術(shù)前(P=0.007,P=0.000,P=0.000,P=0.000); 術(shù)后3個月、6個月及末次隨訪時的膝部疼痛VAS評分均低于術(shù)后1個月(P=0.045,P=0.033,P=0.014); 術(shù)后3個月、6個月及末次隨訪時的膝部疼痛VAS評分兩兩比較,差異均無統(tǒng)計學(xué)意義。結(jié)論:在采用膝關(guān)節(jié)鏡手術(shù)治療合并膝關(guān)節(jié)內(nèi)側(cè)間室狹窄的內(nèi)側(cè)半月板后角損傷時,進行MCL拉花松解能增大膝關(guān)節(jié)內(nèi)側(cè)間隙,改善手術(shù)視野,術(shù)后患者膝關(guān)節(jié)疼痛減輕、功能恢復(fù)良好,并發(fā)癥少。

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通訊作者:張智敏 E-mail:[email protected]
更新日期/Last Update: 1900-01-01