单针由外向内缝合半月板

Single needle outside-in suture of the meniscus

摘要:

[目的] 介绍单针由外向内缝合半月板的手术技术和初步临床结果。[方法] 采用单一注射针头, 头端有侧孔, 带入单股缝线由外向内穿入, 镜下观察带线针头自关节腔内半月板撕裂的内侧缘穿出。镜下将线环引出前侧入口, 回拉针头至皮下, 再次由外向内穿过至半月板撕裂处, 引出线环, 将线环拉大后, 模拟缝纫机原理, 自前侧入口外, 将另一缝线从各线环内部依次导入, 重复该操作完成连续半月板缝合, 首先于第1针处将关节内线头一端引至外侧打结, 再依次逐步收紧缝线, 最后于关节腔内侧打结。缝合完毕后并不需要外侧缝合单个针孔, 皮内缝合关节前侧两个入口。[结果] 10例患者均顺利完成手术, 术中无神经损伤发生, 手术时间平均(45.1±11.8) min, 术后无感染等并发症发生。Lysholm评分从术前的平均(55.1±4.1)分显著提升至术后6个月的(85.6±9.7)分(P<0.001)。术后12个月, 患者满意度评分(满分10分)为(9.2±2.6)分。[结论] 单通道由外向内缝合半月板技术是一种安全、有效的微创手术方法, 显著降低了手术创伤和成本, 缩短了手术时间, 改善患者膝关节功能。

Abstract:

[Objective] To introduce the surgical technique and the preliminary clinical consequence of single needle outside-in suture of the meniscus. [Methods] Using a single injection needle with side hole on the tip, a single-strand suture was introduced outside-in. Under arthroscope, it was observed that the suture needle emerged from the inner edge of the torn meniscus in the joint cavity. The suture loop was drawn out the anterior portal and the needle was pulled back to the subcutaneous layer, then passed through again from the outside to the meniscus tear site. Then, following the principle of a sewing machine, another suture was introduced through each suture loop sequentially outside the anterior portal, with this manipulation repeated to complete the continuous meniscus suture. The first stitch drawn back outside and induced the intra-articular suture thread out to be knotted, then the suture was gradually tightened successively, finally, a knot was made on the inner side of the joint cavity. [Results] All patients had operation performed successfully without nerve injury, while with the average operation time of (45.1±11.8) minutes. No complications such as infection occurred after the operation in anyone of them. The Lysholm score significantly increased from (55.1±4.1) preoperatively to (85.6±9.7) at 6 months after the operation (P<0.001). At 12 months after the operation, the patient satisfaction score (out of 10) was of (9.2±2.6). [Conclusion] The single-needle outside-in suture of meniscus is a safe and effective minimally invasive surgical method, which significantly reduces surgical trauma and costs, shortens the operation time, and improves the knee functional recovery.