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[1]陳帥,嚴(yán)海霞,張宏藝,等.關(guān)節(jié)鏡下“川”字形三針全內(nèi)垂直縫合技術(shù)治療膝關(guān)節(jié)內(nèi)側(cè)半月板桶柄狀撕裂[J].中醫(yī)正骨,2023,35(03):73-77,80.
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關(guān)節(jié)鏡下“川”字形三針全內(nèi)垂直縫合技術(shù)治療膝關(guān)節(jié)內(nèi)側(cè)半月板桶柄狀撕裂()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年03期
頁碼:
73-77,80
欄目:
臨床報道
出版日期:
2023-03-20

文章信息/Info

作者:
陳帥1嚴(yán)海霞2張宏藝1焦鋒1
(1.廣州市中西醫(yī)結(jié)合醫(yī)院,廣東 廣州 510800; 2.廣州中醫(yī)藥大學(xué),廣東 廣州 510405)
關(guān)鍵詞:
膝損傷 半月板 關(guān)節(jié)鏡檢查 縫合技術(shù)
摘要:
目的:觀察關(guān)節(jié)鏡下“川”字形三針全內(nèi)垂直縫合技術(shù)治療膝關(guān)節(jié)內(nèi)側(cè)半月板桶柄狀撕裂(bucket-handle tear of the medial meniscus,BHTMM)的臨床療效和安全性。方法:2016年6月至2021年6月,采用關(guān)節(jié)鏡下“川”字形三針全內(nèi)垂直縫合技術(shù)治療膝關(guān)節(jié)BHTMM患者39例。男23例,女16例。年齡18~55歲,中位數(shù)29歲。左膝18例,右膝21例。新鮮損傷26例,陳舊損傷13例。所有患者均表現(xiàn)為膝關(guān)節(jié)疼痛、酸軟無力、交鎖、屈曲或伸直受限等; 體格檢查均顯示膝關(guān)節(jié)內(nèi)側(cè)間隙壓痛,麥?zhǔn)险骱桶朐掳逖心ピ囼炾栃? 膝關(guān)節(jié)X線檢查均顯示膝關(guān)節(jié)骨質(zhì)無異常或有輕微退變; 膝關(guān)節(jié)MRI檢查均顯示冠狀位上“分離征”,矢狀位上“雙后交叉韌帶征”。BHTMM長度(43.87±4.40)mm。病程1~48周,中位數(shù)6周。記錄手術(shù)時間。術(shù)前和末次隨訪時,測量膝關(guān)節(jié)活動度,采用Lysholm膝關(guān)節(jié)評分標(biāo)準(zhǔn)評價膝關(guān)節(jié)功能,采用《半月板損傷診療與康復(fù)》中半月板損傷的MRI影像學(xué)評價標(biāo)準(zhǔn)和療效評價標(biāo)準(zhǔn)評價半月板愈合情況和臨床療效。術(shù)后隨訪觀察并發(fā)癥發(fā)生及二次手術(shù)情況。結(jié)果:本組患者均順利完成手術(shù),手術(shù)時間30~90 min,中位數(shù)40 min; 均獲隨訪,隨訪時間3~48個月,中位數(shù)12個月。末次隨訪時,39例患者的膝關(guān)節(jié)活動度大于術(shù)前(102.62°±11.96°,124.10°±6.30°,Z=-5.431,P=0.000),Lysholm評分高于術(shù)前[(55.10±9.49)分,(87.46±5.32)分,Z=-5.445,P=0.000],半月板完全愈合28例、部分愈合8例、未愈合3例,顯效28例、有效10例、無效1例。1例患者術(shù)后6個月內(nèi)膝關(guān)節(jié)內(nèi)側(cè)疼痛、交鎖、極度屈曲受限,經(jīng)康復(fù)訓(xùn)練后癥狀逐漸消失。所有患者均無膝關(guān)節(jié)感染、關(guān)節(jié)粘連、下肢深靜脈血栓形成等并發(fā)癥發(fā)生,均未行二次關(guān)節(jié)鏡手術(shù)。結(jié)論:關(guān)節(jié)鏡下“川”字形三針全內(nèi)垂直縫合技術(shù)治療膝關(guān)節(jié)BHTMM,手術(shù)時間短,創(chuàng)傷小,半月板愈合好,能增加膝關(guān)節(jié)活動度、改善膝關(guān)節(jié)功能,療效確切,且并發(fā)癥少。

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備注/Memo

備注/Memo:
基金項目:廣東省中醫(yī)師承“薪火工程”項目(粵中醫(yī)辦〔2021〕5號); 廣州市科技計劃項目(202201010864)
通訊作者:焦鋒 E-mail:[email protected]
更新日期/Last Update: 1900-01-01