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[膝关节半月板修复技术的研究进展]

[Research progress of knee meniscal repair techniques].

作者信息

Feng Jianhao, Xu Yihong, Xu Weidong

机构信息

Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, 200065, P. R. China.

Department of Joint Surgery, the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, 200433, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):885-894. doi: 10.7507/1002-1892.202302103.

DOI:10.7507/1002-1892.202302103
PMID:37460187
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10352505/
Abstract

OBJECTIVE

To review the research progress of meniscus repair in recent years, in order to provide help for the clinical decision-making of meniscus injury treatment.

METHODS

The domestic and foreign literature related to meniscal repair in recent years was extensively reviewed to summarize the reasons for the prevalence of meniscal repair, surgical indications, various repair methods and long-term effectiveness, the need to deal with mechanical structural abnormalities, biological enhancement repair technology, rehabilitation treatment, and so on.

RESULTS

In order to delay the occurrence of osteoarthritis, the best treatment of meniscus has undergone an important change from partial meniscectomy to meniscal repair, and the indications for meniscal repair have been expanding. The mid- and long-term effectiveness of different meniscal repair methods are ideal. During meniscus repair, the abnormality of lower limb force line and meniscus protrusion should be corrected at the same time. There are controversies about the biological enhancement technology to promote meniscus healing and rehabilitation programs, which need further study.

CONCLUSION

Meniscal repair can restore the normal mechanical conduction of lower limbs and reduce the incidence of traumatic osteoarthritis, but the poor blood supply and healing ability of meniscal tissue bring difficulties to meniscal repair. Further development of new biological enhanced repair technology and individualized rehabilitation program and verification of its effectiveness will be an important research direction.

摘要

目的

回顾近年来半月板修复的研究进展,为半月板损伤治疗的临床决策提供帮助。

方法

广泛查阅近年来国内外与半月板修复相关的文献,总结半月板修复盛行的原因、手术指征、各种修复方法及长期疗效、处理机械结构异常的必要性、生物增强修复技术、康复治疗等。

结果

为延缓骨关节炎的发生,半月板的最佳治疗已从部分半月板切除术发生了重要转变,变为半月板修复,且半月板修复的指征不断扩大。不同半月板修复方法的中长期疗效理想。在半月板修复过程中,应同时纠正下肢力线异常和半月板突出。关于促进半月板愈合的生物增强技术和康复方案存在争议,有待进一步研究。

结论

半月板修复可恢复下肢正常的力学传导,降低创伤性骨关节炎的发生率,但半月板组织血供差、愈合能力弱给半月板修复带来困难。进一步研发新的生物增强修复技术和个体化康复方案并验证其有效性将是重要的研究方向。

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本文引用的文献

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Clinical Outcome of Arthroscopic Repair for Isolated Meniscus Tear in Athletes.运动员孤立性半月板撕裂的关节镜修复的临床结果。
Int J Environ Res Public Health. 2023 Mar 14;20(6):5088. doi: 10.3390/ijerph20065088.
2
Return to sports after bucket handle medial meniscus tear repair using inside out technique in recreational sports players.在娱乐性运动参与者中,使用内翻技术修复桶柄状内侧半月板撕裂后重返运动。
Acta Orthop Belg. 2022 Sep;88(3):533-540. doi: 10.52628/88.3.7226.
3
Smaller Iatrogenic Defects Created by Inside-Out Compared With All-Inside Meniscus Repair Devices in Human Cadaveric Model.在人体尸体模型中,与全内半月板修复装置相比,由由内向外技术造成的医源性缺损更小。
Arthroscopy. 2022 Nov;38(11):3070-3079.e3. doi: 10.1016/j.arthro.2022.05.009. Epub 2022 Aug 31.
4
Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up.关节镜下修复 45 岁以上患者的退行性内侧半月板撕裂可获得良好的临床结果,且在至少 2 年的随访中临床失败率较低。
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1815-1823. doi: 10.1007/s00167-022-07133-w. Epub 2022 Sep 22.
5
Arthroscopic meniscus repair and augmentation with autologous fibrin clot in Indian population: A 2-year prospective study.印度人群中关节镜下半月板修复及自体纤维蛋白凝块增强术:一项为期2年的前瞻性研究。
J Clin Orthop Trauma. 2022 Aug 6;32:101969. doi: 10.1016/j.jcot.2022.101969. eCollection 2022 Sep.
6
The Current Role of Biologics for Meniscus Injury and Treatment.生物制剂在半月板损伤及治疗中的当前作用
Curr Rev Musculoskelet Med. 2022 Dec;15(6):456-464. doi: 10.1007/s12178-022-09778-z. Epub 2022 Jul 26.
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Meniscal Repair Outcomes at Greater Than 5 Years: A Systematic Review and Meta-Analysis.半月板修复后 5 年以上的结果:系统评价和荟萃分析。
J Bone Joint Surg Am. 2022 Jul 20;104(14):1311-1320. doi: 10.2106/JBJS.21.01303. Epub 2022 Apr 19.
8
Mesenchymal Stem Cells From Different Sources in Meniscus Repair and Regeneration.半月板修复与再生中不同来源的间充质干细胞
Front Bioeng Biotechnol. 2022 Apr 27;10:796367. doi: 10.3389/fbioe.2022.796367. eCollection 2022.
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Meniscus Repair Part 2: Technical Aspects, Biologic Augmentation, Rehabilitation, and Outcomes.半月板修复第 2 部分:技术方面、生物增强、康复和结果。
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