[1]齐岩松 吴海贺 周慧文 张鹏飞 包呼日查 王永祥 魏宝刚 马秉贤 徐永胜**.关节镜下2种术式治疗外侧半月板后根损伤短期疗效的比较[J].中国微创外科杂志,2023,01(6):462-468.
　Qi Yansong,Wu Haihe,Zhou Huiwen,et al.Two Arthroscopic Surgical Procedures for Treating Posterior Lateral Meniscus Root Tear: a Comparative Study With Shortterm Followups[J].Chinese Journal of Minimally Invasive Surgery,2023,01(6):462-468.
点击复制

关节镜下2种术式治疗外侧半月板后根损伤短期疗效的比较()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年6期
页码:
462-468
栏目:
临床研究
出版日期:
2023-06-25

文章信息/Info

Title:
Two Arthroscopic Surgical Procedures for Treating Posterior Lateral Meniscus Root Tear: a Comparative Study With Shortterm Followups
作者:
齐岩松 吴海贺 周慧文 张鹏飞 包呼日查 王永祥 魏宝刚 马秉贤 徐永胜**
(内蒙古自治区人民医院骨科中心，呼和浩特010017)
Author(s):
Qi Yansong;  Wu Haihe;  Zhou Huiwen;  et al.
Orthopedic Center, Inner Mongolia People’s Hospital, Hohhot 010017, China
关键词:
外侧半月板后根损伤; 半月板缝合术; 半月板止点重建术; 膝关节功能
Keywords:
Posterior lateral meniscus root tear; Allinside repair; Transtibial pullout repair; Knee function
文献标志码:
A
摘要:
目的比较关节镜下半月板缝合术和半月板止点重建术治疗外侧半月板后根损伤(posterior lateral meniscus root tear，PLMRT)的短期疗效。方法回顾性分析2018年1月~2020年9月我院51例2~4型PLMRT(均合并前交叉韧带撕裂)分别采用后根缝合术(缝合组，n=26)或胫骨隧道重建术(重建组，n=25)治疗的临床资料，比较2组Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee，IKDC)评分、膝关节前移距离和Pivotshift试验、前抽屉试验和McMurray试验阳性率。结果随访(16.2±3.7)月，重建组McMurray试验阳性率显著低于缝合组［0(0/25)vs.23.1%(6/26)，Fisher精确检验，P=0.023］，Lysholm评分［(90.4±7.5)分 vs.(84.4±9.2)分，t=3.396，P=0.001］和IKDC评分［(90.3±6.4)分 vs.(86.4±8.8)分，t=3.335，P=0.002］显著高于缝合组。MRI示缝合组外侧半月板后根2级信号发生率显著高于重建组［46.2%(12/26)vs.12.0%(3/25)， χ2=7.161，P=0.007］。2组术后Pivotshift试验阳性率、前移距离差异无显著性(P>0.05)，前抽屉试验均为阴性。结论对于2~4型PLMRT(放射状、桶柄样、混合型)，经胫骨隧道行半月板止点重建术半月板愈合程度更好，膝关节整体功能预后更佳。
Abstract:
ObjectiveTo compare the shortterm clinical efficacy of arthroscopic allinside repair and transtibial pullout repair in the treatment of posterior lateral meniscus root tear (PLMRT).MethodsA retrospective study was conducted to analyze the clinical data of 51 patients with type Ⅱ-Ⅳ PLMRT, with concomitant anterior cruciate ligament (ACL) rupture, in our hospital from January 2018 to September 2020. The patients were divided into the group A (allinside repair, n=26) and the group B (transtibial pullout repair, n=25) according to their surgical options. The Lysholm and International Knee Documentation Committee (IKDC) scores, anterior shift distance, Pivotshift test, anterior drawer test, and positive rate of McMurray test were compared between the two groups. ResultsThe patients were followed up for (16.2±3.7) months. Compared to the group A, the group B showed significant lower positive rate of McMurray test ［0 (0/25) vs. 231% (6/26), Fisher exact test, P=0.023］, and higher Lysholm score ［(90.4±7.5) points vs. (84.4±9.2) points, t=3396, P=0.001］ and IKDC score ［(90.3±6.4) points vs. (86.4±8.8) points, t=3.335, P=0.002］. The MRI showed that the rate of grade 2 signal of posterior lateral meniscus root in the group A was significantly higher than that in the group B ［46.2%(12/26) vs. 12.0%(3/25), χ2=7.161, P=0.007］. The positive rate of Pivotshift test and anterior shift distance did not have significant differences between the two groups (P>0.05), and the results of anterior drawer test were both negative in the two groups. ConclusionFor type Ⅱ-Ⅳ PLMRT (radialshaped, barrelshaped, and mixed type), the transtibial pullout repair can result in better meniscus healing and better overall knee functional outcomes.

参考文献/References:

[1]Edd SN, Giori NJ, Andriacchi TP. The role of inflammation in the initiation of osteoarthritis after meniscal damage. J Biomech,2015,48(8):1420-1426.
[2]苗羽,余家阔.半月板全切、部分切除、修复与膝关节退行性改变的关系.中国运动医学杂志,2008,27(6):779-783,788.
[3]Allaire R, Muriuki M, Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am,2008,90(9):1922-1931.
[4]Ahn JH, Lee YS, Yoo JC, et al. Results of arthroscopic allinside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy,2010,26(1):67-75.
[5]周慧文,徐永胜,包呼日查,等.两种方法治疗退行性内侧半月板后根部损伤疗效比较.中华关节外科杂志(电子版),2021,15(2):171-177.
[6]Brody JM, Lin HM, Hulstyn MJ, et al. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology,2006,239(3):805-810.
[7]LaPrade CM, Jansson KS, Dornan G, et al. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pullout suture repairs. J Bone Joint Surg Am,2014,96(6):471-479.
[8]Zhuo H, Chen Q, Zhu F, Li J. Arthroscopic sidetoside repair for complete radial posterior lateral meniscus root tears. BMC Musculoskelet Disord,2020,21(1):130.
[9]逸弘,朱新辉,范建波,等.关节镜下一期重建修复前交叉韧带撕裂合并外侧半月板后根撕裂的中期疗效.中华临床医师杂志(电子版),2021,15(12): 961-967.
[10]Shelbourne KD, Roberson TA, Gray T. Longterm evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med,2011,39(7):1439-1443.
[11]Papalia R, Vasta S, Franceschi F, et al. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull,2013,106:91-115.
[12]Ahn JH, Lee YS, Chang JY, et al. Arthroscopic all inside repair of the lateral meniscus root tear. Knee,2009,16(1):77-80.
[13]Forkel P, Petersen W. Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL doublebundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg,2012,132(3):387-391.
[14]Musahl V, Citak M, O’Loughlin PF, et al. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligamentdeficient knee. Am J Sports Med,2010,38(8):1591-1597.
[15]Tandogan RN, Ta �瘙 塂 er O, Kayaalp A, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc,2004,12(4):262-270.
[16]De Smet AA, Blankenbaker DG, Kijowski R, et al. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol,2009,192(2):480-486.
[17]Kim JH, Chung JH, Lee DH, et al. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy,2011,27(12):1644-1653.
[18]张鹏飞,齐岩松,包呼日查,等.外侧半月板后根部损伤不同缝合位置对膝关节生物力学的影响.医用生物力学,2019,34(5):507-513.
[19]吴海贺,齐岩松,包呼日查,等.胫骨骨隧道拉出缝合半月板止点重建治疗外侧半月板后根部损伤25例报告.中国微创外科杂志,2021,21(3):231-234.
[20]Hein CN, Deperio JG, Ehrensberger MT, et al. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee,2011,18(3):189-192.
[21]Wenger A, Wirth W, Hudelmaier M, et al. Meniscus body position, size, and shape in persons with and persons without radiographic knee osteoarthritis: quantitative analyses of knee magnetic resonance images from the osteoarthritis initiative. Arthritis Rheum,2013,65(7):1804-1811.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金项目（81560374，81960399，82172444）；内蒙古自治区科技计划项目（2021GG0127）； 内蒙古自治区自然科学基金项目（2017MS08136，2020MS03064）**通讯作者，Email:dlxyf@163.com
更新日期/Last Update: 2023-09-07