影响关节镜修复创伤性垂直纵向内侧半月板撕裂预后的因素
Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears.
作者信息
Uzun Erdal, Misir Abdulhamit, Kizkapan Turan Bilge, Ozcamdalli Mustafa, Akkurt Soner, Guney Ahmet
机构信息
Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey.
Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
出版信息
Orthop J Sports Med. 2017 Jun 23;5(6):2325967117712448. doi: 10.1177/2325967117712448. eCollection 2017 Jun.
BACKGROUND
Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs.
PURPOSE
To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated.
RESULTS
The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both s <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; = .008).
CONCLUSION
Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing.
背景
尽管众多研究已对关节镜下内侧半月板修复进行了评估，但很少有研究关注影响垂直纵向和桶柄状半月板修复结果的因素。
目的
评估影响关节镜下修复创伤性垂直纵向和桶柄状内侧半月板撕裂临床结果的因素。
研究设计
病例系列研究；证据等级为4级。
方法
2007年至2012年间，共有223例患者接受了关节镜下内侧半月板撕裂修复术；140例患者为单纯撕裂或同时进行了前交叉韧带（ACL）重建，80例患者（76例男性，4例女性；平均年龄29.1岁；范围18 - 49岁）有垂直纵向撕裂并纳入本研究。术前和术后的功能状态通过使用Lysholm评分和国际膝关节文献委员会（IKDC）评分的体格检查进行评估。采用巴雷特标准对半月板愈合进行临床评估，磁共振成像（MRI）用作影像学评估方法。还研究了撕裂部位、长度、慢性程度和类型；缝合技术；同时进行的ACL重建；以及患者年龄、性别和吸烟习惯的影响。
结果
平均随访期为51.2±9.4个月（范围34 - 85个月）。末次随访时，Lysholm评分和IKDC评分的平均值均有所改善（均P<.001）。根据临床评分、巴雷特标准和MRI，12例患者（15%）出现修复失败。成功组和失败组在年龄、撕裂长度、撕裂类型、同时存在的ACL断裂、缝合技术或半月板修复位置方面无显著差异。红白区撕裂的失败率高于红 - 红区撕裂（10/30，33.3%对2/50，4%；P =.004）。撕裂的慢性程度显著影响失败率。早期修复的愈合率高于晚期修复（100%对73.4%；P =.008）。吸烟者的失败率高于非吸烟者（9/24，37.5%对3/56，5.3%；P =.008）。
结论
周边撕裂和早期修复具有更好的结果和患者满意度。吸烟对半月板愈合有不利影响。
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