【摘要】 目的 比较关节镜下半月板缝合修复术与部分切除成形术治疗青壮年复杂型半月板撕裂的临床疗效。方法 回顾性分析自2017-01—2023-01采用关节镜手术治疗的45例青壮年复杂型半月板撕裂，观察组24例进行半月板缝合修复，对照组21例进行半月板部分切除成形。比较两组手术时间、术中出血量、住院时间，手术前后膝关节功能Lysholm评分和Tegner评分，以及末次随访时骨性关节炎发生率（评定标准为MRI显示软骨下骨高信号影）。结果 45例均获得随访，随访时间18～24个月，平均21.8个月。未出现切口感染、下肢深静脉血栓形成、神经血管损伤等并发症。观察组手术时间、住院时间较对照组长，术中出血量较对照组多，差异有统计学意义（P<0.05）。观察组术后3个月MRI显示1例半月板缝合端再撕裂，再撕裂发生率为4.2%；末次随访时MRI显示19例半月板达到愈合标准，愈合率为79.2%；根据Barrett标准评估，20例达到临床愈合标准，愈合率为83.3%。观察组与对照组膝关节功能Lysholm评分及Tegner评分在组别、时间、交互效应上差异均有统计学意义（P<0.05），术后评分均较术前明显提高，且观察组评分高于对照组。末次随访时观察组10例出现软骨下骨高信号影，骨性关节炎发生率为41.7%，对照组19例出现软骨下骨高信号影，骨性关节炎发生率为90.5%；观察组骨性关节炎发生率明显低于对照组，差异有统计学意义（P<0.05）。结论 关节镜下半月板缝合修复术治疗青壮年复杂型半月板撕裂可取得满意疗效，虽然该术式操作难度较高、手术时间及住院时间更长，但是患者远期膝关节功能恢复明显优于半月板部分切除成形术。更多还原

【Abstract】 Objective To compare the clinical efficacy between arthroscopic meniscal suture repair vs. partial meniscectomy and meniscoplasty for the treatment of complex meniscal tears in young and middle-aged adults.Methods A retrospective analysis was conducted on 45 young and middle-aged adults with complex meniscus tears treated with arthroscopic surgery from January 2017 to January 2023. The observation group consisted of 24 cases who underwent meniscus suture repair, while the control group consisted of 21 cases who underwent partial meniscectomy and meniscoplasty. The surgical time, intraoperative blood loss, hospital stay, Lysholm score and Tegner score of knee joint function before and after surgery were compared, as well as the incidence of osteoarthritis at the last follow-up(osteoarthritis assessment standard was MRI showing high signal intensity of subchondral bone) between two groups.Results All 45 cases were followed up for 18 to 24 months, with an average of 21.8 months. There were no complications such as incision infection, lower limb deep vein thrombosis, or neurovascular injury. The observation group had longer surgery time and hospitalization time and more intraoperative bleeding compared to the control group, with statistically significant differences(P<0.05). Three months after surgery, in the observation group MRI showed re-rupture of meniscus at the suture end in one case, with a re-rupture incidence rate of 4.2%; At the last follow-up,MRI showed that 19 cases of meniscus had reached the healing standard, with a healing rate of 79.2%; According to Barrett’s criteria, 20 cases met the clinical healing criteria, with a healing rate of 83.3%. The Lysholm score and Tegner score of knee joint function between the observation group and the control group showed statistically significant differences in group, time,and interaction effects(P<0.05). Postoperative scores were significantly improved compared to preoperative scores, and the observation group had higher scores than the control group. At the last follow-up, 10 cases in the observation group showed subchondral bone hyperintensities, with an incidence rate of 41.7% for osteoarthritis, while 19 cases in the control group showed subchondral bone hyperintensities, with an incidence rate of 90.5% for osteoarthritis; The incidence of osteoarthritis in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05).Conclusion Arthroscopic meniscus suture repair surgery can achieve satisfactory results in the treatment of complex meniscus tears in young and middle-aged adults. Although this procedure is more difficult to operate with longer operation time and hospital stay, the long-term recovery of knee joint function in patients is significantly better than partial meniscectomy and meniscoplasty.更多还原