外伤性膝内侧副韧带损伤直接缝合与带线锚钉缝合比较分析
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摘要
目的探讨外伤性膝内侧副韧带损伤直接缝合与带线锚钉缝合的临床疗效。方法选择2014年7月至2017年7月上海市闵行区中西医结合医院诊治的68例外伤性膝内侧副韧带损伤患者,其中男性40例,女性28例;年龄20～41岁,平均年龄27.96岁。根据缝合方式将其分为2组,其中直接缝合组38例(38膝),带线锚钉缝合组30例(30膝)。比较两组患者围手术期相关指标、术后1年膝关节功能及稳定性情况。结果带线锚钉缝合组手术时间和术中出血量明显低于直接缝合组,但治疗费用明显高于直接缝合组,差异有统计学意义(P <0.05)。两组患者术后均未出现明显的切口愈合不良、切口感染等并发症。两组患者术后1年时国际膝关节文献委员会(IKDC)膝关节量表评分、Lysholm评分均高于术前[直接缝合组(88.24±1.28)分vs (54.34±4.54)分,(87.28±2.37)分vs (41.65±2.38)分;带线锚钉缝合组(94.12±1.34)分vs (54.57±4.28)分,(92.65±1.25)分vs (42.35±2.64)分];带线锚钉缝合组患者术后1年IKDC膝关节量表评分、Lysholm评分显著高于直接缝合组,差异均有显著统计学意义(P <0.01)。两组患者术后1年Lysholm试验和Pivotshift试验阳性率均明显低于术前[直接缝合组15.79%vs 100.00%,18.42%vs 100.00%;带线锚钉缝合组0.00%vs100.00%,0.00%vs 100.00%];直接缝合组术后1年的Lysholm试验和Pivot-shift试验阳性率高于带线锚钉缝合组,差异有统计学意义(P <0.05)。结论带线锚钉治疗外伤性膝内侧副韧带损伤能够使受损膝关节获得满意的稳定性和功能,术后恢复快,若患者经济条件允许,优先推荐使用带线锚钉修复外伤性膝内侧副韧带损伤。
Objective To detect the clinical effect of direct suture for traumatic medial collateral ligament injury and suture anchor suture. Methods From July 2014 to July 2017, a total of 68 patients with traumatic medial collateral ligament injury were enrolled, which included 40 males and 28 females, aged 20-41 years old with mean age of 27.96 years old. According to suture method, all of them were divided into direct suture group(n = 38) and suture anchor suture group(n = 30) by suture method.The perioperative related indicators, the knee joint function and stability 1-year post-operation between 2 groups were compared. Results The operation time and intraoperative blood loss of suture anchor suture group were significantly lower than those of direct suture group, but the cost was significantly higher than that of direct suture group. The difference was statistically significant(P < 0.05). There were no obvious complications such as poor healing of incision and infection of incision in 2 groups.The International Knee Documentation Committee(IKDC) knee joint scale score 1-year post-operation were higher than before operation[direct suture group was(88.24 ± 1.28) scores vs(54.34 ± 4.54) scores,(87.28 ± 2.37) scores vs(41.65 ± 2.38) scores;suture anchor suture group was(94.12 ± 1.34) scores vs(54.57 ± 4.28) scores,(92.65 ± 1.25) scores vs(42.35 ± 2.64) scores]; The IKDC knee joint scale score and Lysholm score 1-year post-operation of suture anchor suture group were statistically significantly higher than those in direct suture group(P < 0.01); The positive rate of Lysholm test and Pivot-shift test after operation were significantly lower than those of before operation in 2 groups(direct suture group was 15.79 % vs 100.00 %, 18.42 % vs100.00 %; suture anchor suture group was 0.00 % vs 100.00 %, 0.00 % vs 100.00 %). The positive rates of Lysholm test and Pivot-shift test in direct suture group were statistically significant higher than those in suture anchor suture group after treatment for 1-year(P < 0.05). Conclusion It is demonstrated that the suture anchor suture treatment of traumatic knee medial collateral ligament injury showed stability and satisfactory function and rapid postoperative recovery in injured knee. It is preferred to use suture anchor suture to repair traumatic knee medial collateral ligament injury if the economically permissible.
Objective To detect the clinical effect of direct suture for traumatic medial collateral ligament injury and suture anchor suture. Methods From July 2014 to July 2017, a total of 68 patients with traumatic medial collateral ligament injury were enrolled, which included 40 males and 28 females, aged 20-41 years old with mean age of 27.96 years old. According to suture method, all of them were divided into direct suture group(n = 38) and suture anchor suture group(n = 30) by suture method.The perioperative related indicators, the knee joint function and stability 1-year post-operation between 2 groups were compared. Results The operation time and intraoperative blood loss of suture anchor suture group were significantly lower than those of direct suture group, but the cost was significantly higher than that of direct suture group. The difference was statistically significant(P < 0.05). There were no obvious complications such as poor healing of incision and infection of incision in 2 groups.The International Knee Documentation Committee(IKDC) knee joint scale score 1-year post-operation were higher than before operation[direct suture group was(88.24 ± 1.28) scores vs(54.34 ± 4.54) scores,(87.28 ± 2.37) scores vs(41.65 ± 2.38) scores;suture anchor suture group was(94.12 ± 1.34) scores vs(54.57 ± 4.28) scores,(92.65 ± 1.25) scores vs(42.35 ± 2.64) scores]; The IKDC knee joint scale score and Lysholm score 1-year post-operation of suture anchor suture group were statistically significantly higher than those in direct suture group(P < 0.01); The positive rate of Lysholm test and Pivot-shift test after operation were significantly lower than those of before operation in 2 groups(direct suture group was 15.79 % vs 100.00 %, 18.42 % vs100.00 %; suture anchor suture group was 0.00 % vs 100.00 %, 0.00 % vs 100.00 %). The positive rates of Lysholm test and Pivot-shift test in direct suture group were statistically significant higher than those in suture anchor suture group after treatment for 1-year(P < 0.05). Conclusion It is demonstrated that the suture anchor suture treatment of traumatic knee medial collateral ligament injury showed stability and satisfactory function and rapid postoperative recovery in injured knee. It is preferred to use suture anchor suture to repair traumatic knee medial collateral ligament injury if the economically permissible.
引文
[1] WANG Jun-yi, NI Xiao-hui, ZHANG Lu, et al. Clinical efficacy of suture anchor for treatment of medial collateral figamentⅢinjuries of knee[J]. Orthopaedic Biomechanics Materials and Clinical Study, 2018, 15(1):35-37.[王俊义,倪晓辉,张卢,等.带线锚钉治疗Ⅲ度膝关节内侧副韧带损伤临床疗效观察[J].生物骨科材料与临床研究,2018,15(1):35-37.]
[2] Huang YJ, Chen WL, Zhang L, et al. Suture anchor for acute injuries of medial collateral ligament of knee at degreeⅢ[J].Zhongguo Gu Shang, 2014, 27(2):137-139.[黄益奖,陈文良,张雷,等.缝合锚定治疗急性膝关节内侧副韧带止点损伤的临床疗效[J].中国骨伤,2014,27(2):137-139.]
[3] Kini SG, du Pre K, Bruce W. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury[J]. Chin J Traumatol, 2015, 18(6):367-369.
[4] Sonare A, Deshpande NK, Rahule AS. Role of physiotherapy in the management of medial collateral ligament injuries of knee joints[J]. J Cont Med A Dent, 2015, 3(1):54-57.
[5] XU Hong-tao, DONG Jiang-tao, WANG Juan, et al. Clinical therapeutic strategy for injuries of the medial collateral ligament and anterior cruciate ligament[J]. Orthopedic Journal of China, 2017, 25(2):132-135.[许宏涛,董江涛,王娟,等.内侧副韧带合并前交叉韧带损伤的临床治疗策略[J].中国矫形外科杂志,2017,25(2):132-135.]
[6] Tokunaga S, Abe Y. Novel suture anchor technique with continuous locking stitch for collateral ligament repair[J]. J Hand Surg Asian Pac Vol, 2016, 21(2):276-276.
[7] HUANG Ye-jian, SUN Ke-fu. Clinical analysis of the repair of the medial collateral ligament of the knee with the wire anchor and the anchor pin[J]. Chinese Medicine and Pharmacy, 2015, 5(22):174-177.[黄叶建,孙克富.带线锚钉固定修复膝关节内侧副韧带的临床分析[J].中国医药科学,2015,5(22):174-177.]
[8] SONG Wei, XUE Zhao-xue. Repair of medial collateral ligament rupture of knee joint by transposition of semitendinosus muscle and ligament anastomosis[J]. Shanxi Medical Journal,2012, 41(17):909-911.[宋伟,薛兆学.半腱肌转位联合韧带吻合修复膝关节内侧副韧带断裂[J].山西医药杂志,2012,41(17):909-911.]
[9] SUN Tie-cheng, LüSong-cen. Progress of diagnosis and surgical treatment for medial collateral ligament sprain of the knee joint[J]. Chinese Journal of Bone and Joint, 2017, 6(6):469-475.[孙铁成,吕松岑.膝内侧副韧带损伤诊断与手术治疗进展[J].中国骨与关节杂志,2017,6(6):469-475.]
[10] LIN Ang-ru, HU Ba-sheng, GUO Gang. The improved method for repairing injury of medial accessory ligament of knee joint[J]. China Journal of Orthopaedics and Traumatology,2002, 15(2):68-70.[林昂如,胡罢生,郭刚.膝关节内侧副韧带损伤修复方法改进[J].中国骨伤,2002,15(2):68-70.]
[11] ZHU Ya-bin, LI Qiang, WANG Jian. Clinical observation of the treatment of medial collateral ligament of knee joint femoral condyle rupture with suture anchor[J]. Orthopaedic Biomechanics Materials and Clinical Study, 2017, 14(3):38-40.[朱亚斌,李强,王剑.带线锚钉治疗膝关节内侧副韧带股骨髁止点断裂的临床观察[J].生物骨科材料与临床研究,2017,14(3):38-40.]
[12] ZHAO Zhen-gang, LI Gui-bin, DAI Bin,et al. Comparison of anchor fixation and autologous ligament in the treatment of medial collateral ligament injury of knee joint[J]. China Practical Medicine, 2016, 11(31):67-69.[赵振刚,李贵斌,戴彬,等.锚钉固定与采用自体韧带治疗膝关节内侧副韧带损伤的比较分析[J].中国实用医药,2016,11(31):67-69.]
[13] Forkel P, Seppel G, Imhoff A, et al. Suturing and refixation of the medial collateral ligament in severe acute medial instability of the knee[J]. Oper Orthop Traumatol, 2015, 27(2):155-171.
[14] Bohl DD, Wetters NG, Del Gaizo DJ, et al. Repair of intraoperative injury to the medial collateral ligament during primary total knee arthroplasty[J]. J Bone Joint Surg Am, 2016,98(1):35-39.
[2] Huang YJ, Chen WL, Zhang L, et al. Suture anchor for acute injuries of medial collateral ligament of knee at degreeⅢ[J].Zhongguo Gu Shang, 2014, 27(2):137-139.[黄益奖,陈文良,张雷,等.缝合锚定治疗急性膝关节内侧副韧带止点损伤的临床疗效[J].中国骨伤,2014,27(2):137-139.]
[3] Kini SG, du Pre K, Bruce W. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury[J]. Chin J Traumatol, 2015, 18(6):367-369.
[4] Sonare A, Deshpande NK, Rahule AS. Role of physiotherapy in the management of medial collateral ligament injuries of knee joints[J]. J Cont Med A Dent, 2015, 3(1):54-57.
[5] XU Hong-tao, DONG Jiang-tao, WANG Juan, et al. Clinical therapeutic strategy for injuries of the medial collateral ligament and anterior cruciate ligament[J]. Orthopedic Journal of China, 2017, 25(2):132-135.[许宏涛,董江涛,王娟,等.内侧副韧带合并前交叉韧带损伤的临床治疗策略[J].中国矫形外科杂志,2017,25(2):132-135.]
[6] Tokunaga S, Abe Y. Novel suture anchor technique with continuous locking stitch for collateral ligament repair[J]. J Hand Surg Asian Pac Vol, 2016, 21(2):276-276.
[7] HUANG Ye-jian, SUN Ke-fu. Clinical analysis of the repair of the medial collateral ligament of the knee with the wire anchor and the anchor pin[J]. Chinese Medicine and Pharmacy, 2015, 5(22):174-177.[黄叶建,孙克富.带线锚钉固定修复膝关节内侧副韧带的临床分析[J].中国医药科学,2015,5(22):174-177.]
[8] SONG Wei, XUE Zhao-xue. Repair of medial collateral ligament rupture of knee joint by transposition of semitendinosus muscle and ligament anastomosis[J]. Shanxi Medical Journal,2012, 41(17):909-911.[宋伟,薛兆学.半腱肌转位联合韧带吻合修复膝关节内侧副韧带断裂[J].山西医药杂志,2012,41(17):909-911.]
[9] SUN Tie-cheng, LüSong-cen. Progress of diagnosis and surgical treatment for medial collateral ligament sprain of the knee joint[J]. Chinese Journal of Bone and Joint, 2017, 6(6):469-475.[孙铁成,吕松岑.膝内侧副韧带损伤诊断与手术治疗进展[J].中国骨与关节杂志,2017,6(6):469-475.]
[10] LIN Ang-ru, HU Ba-sheng, GUO Gang. The improved method for repairing injury of medial accessory ligament of knee joint[J]. China Journal of Orthopaedics and Traumatology,2002, 15(2):68-70.[林昂如,胡罢生,郭刚.膝关节内侧副韧带损伤修复方法改进[J].中国骨伤,2002,15(2):68-70.]
[11] ZHU Ya-bin, LI Qiang, WANG Jian. Clinical observation of the treatment of medial collateral ligament of knee joint femoral condyle rupture with suture anchor[J]. Orthopaedic Biomechanics Materials and Clinical Study, 2017, 14(3):38-40.[朱亚斌,李强,王剑.带线锚钉治疗膝关节内侧副韧带股骨髁止点断裂的临床观察[J].生物骨科材料与临床研究,2017,14(3):38-40.]
[12] ZHAO Zhen-gang, LI Gui-bin, DAI Bin,et al. Comparison of anchor fixation and autologous ligament in the treatment of medial collateral ligament injury of knee joint[J]. China Practical Medicine, 2016, 11(31):67-69.[赵振刚,李贵斌,戴彬,等.锚钉固定与采用自体韧带治疗膝关节内侧副韧带损伤的比较分析[J].中国实用医药,2016,11(31):67-69.]
[13] Forkel P, Seppel G, Imhoff A, et al. Suturing and refixation of the medial collateral ligament in severe acute medial instability of the knee[J]. Oper Orthop Traumatol, 2015, 27(2):155-171.
[14] Bohl DD, Wetters NG, Del Gaizo DJ, et al. Repair of intraoperative injury to the medial collateral ligament during primary total knee arthroplasty[J]. J Bone Joint Surg Am, 2016,98(1):35-39.