前交叉韧带断裂并内侧半月板桶柄撕裂的镜下治疗（开放获取）

Arthroscopic treatment of anterior cruciate ligament rupture complicated with medial meniscus bucket-handle tear

摘要:

[目的] 评价镜下前交叉韧带 （anterior cruciate ligament, ACL） 单束重建与半月板缝合治疗 ACL 断裂并内侧半月板桶柄撕裂 （bucket-handle tear, BHT） 的临床效果。[方法] 回顾性分析 2017 年 5 月—2020 年 5 月上述镜下手术治疗 ACL 断裂同时合并内侧半月板 BHT 的 38 例患者，评价临床和影像资料。[结果] 患者均顺利完成手术，术中无血管、神经损伤等严重并发症，手术时间平均（93.0±35.6）min。平均随访时间（2.0±0.4）年， 与术前相比，末次随访 VAS 评分 [(6.4±1.8), (0.4±0.6), P＜0.001]、2000 IKDC 评分 [(37.0±20.3), (94.3±4.8), P＜0.001]、Lysholm 评分 [(41.7±23.8), (95.0±3.9), P＜0.001]、膝伸-屈 ROM [(97.7±28.5)°, (130.8±11.0)°, P＜0.001] 均显著改善。抽屉试验 [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001]、Lachman 试验 [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001] 、轴移试验 [阴性/弱阳性/阳性, (21/9/8), (38/0/0), P＜0.001] 均显著改善 。术后 2 年，二次镜检显示半月板完全愈合 18 例（47.3%），部分愈合 12 例（31.6%），不愈合 8 例（21.1%）。[结论]镜下重建前交叉韧带同时缝合桶柄样撕裂的内侧半月板可以减轻膝关节疼痛，改善功能；38 例半月板中有 30 例获得完全愈合或部分愈合。

Abstract:

[Objective] To evaluate the clinical outcome of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) and meniscus suture in the treatment of ACL rupture complicated with medial meniscus buck-handle tear (BHT). [Methods] A retrospective research was done on 38 patients had ACL rupture combined with medial meniscus BHT treated surgically by abovementioned technique from May 2017 to May 2020. The clinical and imaging data were evaluated. [Results] All the patients had operation performed successfully without any serious complications such as vascular and nerve injury, whereas with the average operation time of (93.0±35.6) min, and were followed up for (2.0±0.4) years in a mean. Compared with those preoperatively, the VAS score [(6.4±1.8), (0.4±0.6), P＜ 0.001], and 2000 IKDC score [(37.0±20.3), (94.3±4.8), P＜0.001], Lysholm score [(41.7±23.8), (95.0±3.9), P＜0.001], knee extension-flexion range of motion (ROM) [(97.7±28.5)°, (130.8±11.0)°, P＜0.001] were significantly improved at the latest follow-up. In addition, the anterior drawer test [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001], Lachman tests [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001], pivot shift test [negative/weakly positive/positive, (21/9/8), (0/38/0), P＜0.001] were significantly improved correspondingly. The second arthroscopic look 2 years after operation revealed the meniscus completely healed in 18 cases (47.3%), partially healed in 12 cases (31.6%), and not healed in 8 cases (21.1%). [Conclusion] The arthroscopic single-bundle ACL reconstruction and meniscus suture do alleviate knee pain and improve knee function for ACL rupture complicated with medial meniscus buck-handle tear, with meniscus healed completely or partially in 30 of 38 cases.