内侧半月板IV型Ramp损伤两种缝合方法比较

Comparison of two suture methods for type IV medial meniscal ramp lesion

摘要:

[目的] 比较关节镜下缝合钩和 Fast-fix 缝合 IV 型半月板 Ramp 区损伤的临床疗效。[方法] 回顾性分析 2016 年 1 月—2020 年 10 月 45 例前交叉韧带（anterior cruciate ligament, ACL）损伤合并 IV 型半月板 Ramp 损伤患者的临床资料。所有患者均取自体腘绳肌腱行 ACL 重建，依据术前医患沟通结果，21 例应用缝合钩缝合 Ramp 损伤，24 例应用 Fast-fix 缝合。对比患者围手术期、随访及影像学结果。[结果]所有患者均顺利完成手术，术中未出现血管、神经损伤等并发症。缝合钩组手术时间 [(91.2±10.6) min vs (62.5±8.4) min, P＜0.001]、切口总长度 [(5.9±0.5) cm vs (5.1±0.6) cm, P＜0.001] 均显著长于 Fast-fix 组，但前者住院费用显著少于后者 [(3.4±0.3) 万元 vs (4.3±0.7) 万元, P＜0.001]。两组 Ramp 撕裂长度、缝合针数、下地行走时间、切口愈合、住院时间比较差异均无统计学意义 （P＞0.05）。所有患者均获 36~72 个月随访。两组完全负重活动时间的差异无统计学意义（P＞0.05）。术后 1 年及末次随访时，两组膝间隙压痛、麦氏征，轴移征、膝关节屈伸 ROM、IKDC 评分及 Lysholm 评分较术前均显著改善 （P＜0.05）。同一时间点，两组上述指标的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，术后 1 年， 两组半月板损伤分级及胫骨平台后侧骨髓水肿均显著改善（P＜0.05），相应时间点，两组上述指标的差异均无统计学意义（P＞ 0.05）。术后 1 年 MRI 显示缝合钩组愈合率为 90.5%、Fast-fix 组为 87.5%，差异无统计学意义 （P＞0.05）。[结论] 关节镜下缝合钩和 Fast-fix 缝合半月板 Ramp 区 IV 型损伤均可获得满意疗效。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic repair of type IV medial meniscal ramp lesion with suture hook (SH) versus Fast-fix (FF). [Methods] A retrospective study was conducted on 45 patients who received arthroscopic surgery for anterior cruciate ligament (ACL) tear combined with type IV medial meniscal ramp lesion from January 2016 to October 2020. All patients underwent ACL reconstruction with autologous hamstring tendon, however, 21 cases of them had medial meniscal ramp lesion repaired by using SH, and 24 cases were by using FF based on the preoperative doctor-patient communication. The perioperative period, follow-up and imaging results were compared between the two cohorts. [Results] All patients in both groups had operation done successfully without complications such as vascular and nerve injury during the operation. The SH group consumed significantly longer operation time [(91.2±10.6) min vs (62.5±8.4) min, P＜0.001], and total length of incision [cm (5.9±0.5) vs (5.1±0.6) cm, P＜0.001] than the FF group, but the former spend significantly less hospitalization cost than the latter [(3.4±0.3) ten-thousand yuan vs (4.3±0.7) ten-thousand yuan, P＜0.001]. There were no significant differences in ramp lesion length, number of meniscal stitches, walking time, incision healing grade and hospital stay between the two groups (P＞0.05). All patients were followed up from 36 months to 72 months, and there was no significant difference between the two groups in time to resume full-weight bearing activity (P＞0.05). The knee joint space tenderness, McMurray sign, pivot shift sign, knee flexionextension ROM, IKDC and Lysholm scores significantly improved in both groups 1 year after surgery and at the last followup compared with those preoperatively (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). As for imaging, the meniscus injury grade and posterior tibial plateau bone marrow edema were significantly improved in both groups 1 year after surgery (P＜0.05), and no statistical significance in the above indexes was noted between the two groups at any corresponding time points (P＞0.05). One year after surgery, MRI showed that the healing rate of the lesion was of 90.5% in SH group, while 87.5% in the FF group, with no statistical significance between them (P＞0.05). [Conclusion] Arthroscopic repair of type IV medial meniscal ramp lesion with both suture hook and Fast-fix do obtain satisfactory clinical consequences.