标题：关节镜下“内-外”缝合法和“全内”缝合法在膝关节外侧盘状半月板损伤治疗中的应用

      作者：孙鹏霄，朱庆生，方庆，段永宏，尹大宇，何明，薛刚    西安国际医学中心医院关节一科，陕西 西安 710000

      卷次： 2023年34卷24期

      【摘要】 目的 比较关节镜下“内-外”缝合法和“全内”缝合法治疗膝关节外侧盘状半月板损伤的效果。方法 选取2020年2月至2022年3月期间西安国际医学中心医院关节一科收治的120例膝关节外侧盘状半月板损伤患者纳入研究，按随机数表法分为内外组和全内组各60例。内外组患者使用“内-外”缝合法，全内组患者使用“全内”缝合法。比较两组患者的疗效、手术指标(包括手术时间、术时出血及住院时间)、患肢膝关节功能评分[包括 Lysholm膝关节功能评分及国际膝关节评分委员会(IKDC)评分]、疼痛评分(VAS)和膝关节本体感觉差值。结果 全内组患者的治疗总优良率为93.33%，明显高于内外组的78.33%，差异有统计学意义(P<0.05)；全内组患者的手术时间为(37.26±8.57) min，明显短于内外组(45.87±9.32) min，差异有统计学意义(P<0.05)，而两组患者术时出血量及住院时间比较差异均无统计学意义(P>0.05)；全内组患者的Lysholm评分、IKDC评分分别为(87.19±7.43)分、(80.07±8.03)分，明显高于内外组的(76.77±7.39)分、(73.66±7.32)分，VAS评分为(1.25±0.23)分，明显低于内外组的(1.65±0.33)分，差异均有统计学意义(P<0.05)；全内组患者15°、45°及75°膝关节本体感觉差值分别为(3.61±0.25)°、(2.93±0.36)°、(3.13±0.37)°，明显低于内外组的(3.93±0.23)°、(3.45±0.33)°、(3.68±0.31)°，差异均有统计学意义(P<0.05)。结论 “全内”缝合法治疗膝关节外侧盘状半月板损伤的疗效更加确切，其能明显缩短手术时间，改善膝关节功能，降低术后疼痛感，提高膝关节感觉能力。
      【关键词】 膝关节外侧盘状半月板损伤；“内-外”缝合法；“全内”缝合法；膝关节功能；疗效
      【中图分类号】 R684 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3573—05

Application of inside-out suture and total internal suture under arthroscope in the treatment of discoid lateralmeniscus injury.
SUN Peng-xiao, ZHU Qing-sheng, FANG Qing, DUAN Yong-hong, YIN Da-yu, HE Ming, XUE Gang.Joint Department 1, Xi'an International Medical Center Hospital, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To compare the effects of inside-out suture and total internal suture under arthroscopein the treatment of discoid lateral meniscus injury. Methods A total of 120 patients with discoid lateral meniscus injurywho were admitted to the Joint Department 1, Xi'an International Medical Center Hospital from February 2020 to March2022 were included in the study. They were divided into the inside-out group (received inside-out suture) and the total in-ternal group (received total internal suture) by random number table method, with 60 cases in each group. Curative effect,operation indicators (operation time, intraoperative blood loss, and length of hospital stay), knee function [Lysholm kneefunction score and International Knee Documentation Committee (IKDC) score], pain degree (Visual Analogue Scale,VAS), and knee proprioception difference were compared between the two groups. Results The excellent and good rateof treatment in the total internal group (93.33%) was significantly higher than that in the inside-out group (78.33%), andthe difference was statistically significant (P<0.05). Operation time of the total internal group was significantly shorterthan that of the inside-out group: (37.26±8.57) min vs (45.87±9.32) min, P<0.05. There was no statistically significantdifference in intraoperative blood loss or length of hospital stay between the two groups (P>0.05). Lysholm score and IK-DC score of the total internal group were (87.19±7.43) points and (80.07±8.03) points, significantly higher than (76.77±7.39) points and (73.66±7.32) points of the inside-out group; the VAS score was (1.25±0.23) points, significantly lowerthan (1.65±0.33) points of the inside-out group; the differences were statistically significant (P<0.05). Knee proprioceptiondifferences of the total internal group at 15°, 45°, and 75° were (3.61±0.25)°, (2.93±0.36)°, and (3.13±0.37)°, significantlysmaller than (3.93±0.23)°, (3.45±0.33)°, and (3.68±0.31)° in the inside-out group (P<0.05). Conclusion Total internal su-ture is more effective in the treatment of discoid lateral meniscus injury. It can significantly shorten the operation time,improve knee function, relieve postoperative pain, and improve knee sensation and cytokine levels.
      【Key words】 Discoid lateral meniscus injury; Inside-out suture; Total internal suture; Knee function; Curative ef-fect