前十字韧带重建术中修复外侧半月板后根部损伤的早期疗效

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目的:探讨外侧半月板后根部(lateral meniscus posterior root,LMPR)修复联合前十字韧带(anterior cruciate ligament,ACL)重建术治疗合并LMPR慢性撕脱损伤的ACL撕裂的临床疗效。方法:回顾性分析2015年7月至2017年6月LMPR慢性撕脱合并ACL撕裂患者33例,男30例,女3例;年龄(27.7±7.5)岁(范围17~45岁)。由同一术者施行胫骨隧道拉出式LMPR修复自体腘绳肌腱ACL解剖单束重建术,随访2年以上。根据二次关节镜下探查结果评估半月板愈合,根据Lysholm和Tegner评分评估膝关节主观功能,根据麻醉下KT-1000侧侧差值和轴移试验评估膝关节客观稳定性,根据矢状面MRI上胫骨前移距离评估股骨-胫骨静态位置关系。以术前胫骨前移距离进行分组,前移至少6 mm者(前移阳性组)18例,前移小于6 mm者(前移阴性组)15例,比较术前及术后2年两组患者胫骨前移距离及其降低程度的差异。结果:所有患者随访(27.5±4.0)个月(范围24~39个月)。LMPR完全愈合23例(70%)、部分愈合9例(27%)、不愈合1例(3%)。Lysholm评分由(60.4±13.6)分提高至术后1年的(82.7±11.1)分、术后2年的(91.4±9.1)分(n F=155.996,n P<0.001);Tegner评分由3(2,5)分[n M(n P25,n P75)]提高至术后1年的4(3,5)分、术后2年的6(4,6)分(χn 2=47.791,n P<0.001)。KT-1000侧侧差值由(9.1±3.3)mm降低至(2.0±1.7)mm(n t=11.197,n P<0.001);轴移试验由Ⅰ度10例、Ⅱ度20例、Ⅲ度3例改善至正常30例、Ⅰ度3例(n U=5.161,n P<0.001)。胫骨前移距离由(5.7±3.9)mm减少至(3.5±3.2)mm(n t=3.530,n P=0.001)。术后2年,前移阳性组的胫骨前移由(8.7±1.8)mm下降至(5.0±3.3)mm(n t=4.765,n P<0.001),前移阴性组的胫骨前移与术前比较差异无统计学意义(n t=0.400,n P=0.695)。前移阳性组胫骨前移下降幅度为(3.7±3.3)mm,大于前移阴性组的(0.3±2.8)mm(n t=3.115,n P=0.004)。n 结论:胫骨隧道拉出式LMPR修复联合ACL重建术治疗合并LMPR慢性撕脱损伤的ACL撕裂,术后2年半月板愈合率高;膝关节主观功能及客观稳定性提高,能够有效改善术前胫骨前移≥6 mm患者的股骨-胫骨静态位置关系。“,”Objective:To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction.Methods:From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/mn 2 (range 19.4-36.7 kg/mn 2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared.n Results:After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively (n F=155.996, n P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χn 2=47.791, n P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm (n t=11.197, n P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperativelyn vs 30 grade 0, 3 grade I, postoperatively, n U=5.161, n P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm (n t=3.530, n P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group (n t=0.400, n P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm (n t=4.765, n P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mmn vs 0.3±2.8 mm, n t=3.115, n P=0.004).n Conclusion:In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.
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