柯迪峰+宋洋+蒋欢

[摘要]目的 观察关节镜治疗膝关节前交叉韧带（ACL）损伤合并半月板后角纵行撕裂（Ramp损伤）的近期临床效果。方法 选择我科2006年3月～2010年3月接受关节镜下韧带重建+半月板修补手术治疗的50例ACL损伤合并内侧半月板Ramp损伤患者为研究对象。比较其手术前后的IKDC评分、Lysholm评分及恢复情况。结果 术后3例患者前抽屉实验及Lachman试验结果为弱阳性，47例患者前抽屉实验及Lachman试验结果呈阴性；与术前比较，患侧术后IKDC评分、Lysholm评分、前抽屉实验及膝关节Lachman试验检查差异有统计学意义（P<0.01）。最终随访时，所有患者均已进行正常的生活，全部患者未出现关节交锁及关节不稳症状，10例患者已进行剧烈体育活动，5例患者在深蹲时存在膝关节内侧疼痛。术后复查膝关节MRI可见31例患者内侧半月板后角的信号恢复正常，19例患者内侧半月板后交存在Ⅱ级信号，MRI检查的愈合率为100%。结论 早期关节镜治疗ACL损伤合并内侧半月板Ramp损伤近期疗效满意，是一种有效的手术方式，远期疗效尚待观察。

[关键词]关节镜；前交叉韧带损伤；半月板Ramp损伤

[中图分类号] R686 [文献标识码] A [文章编号] 1674-4721（2016）06（c）-0047-04

[Abstract]Objective To observe the recent clinical effects of arthroscope in treating anterior cruciate ligament （ACL） injury combined with longitudinal tear meniscus （Ramp） injury.Methods 50 anterior cruciate ligament injury combined with medial meniscus （Ramp） injury patients，accepted ligament reconstruction and meniscus repair under arthroscope，from March 2006 to March 2010 of our department were selected as study objects.The IKDC score before and after operation，Lysholm score and recovery situation were compared.Results After operation，anterior drawer test and Lachman test results of 3 patients were weak positive and 47 cases were negative；compared with preoperative，the affected side postoperative Lysholm score，IKDC score and knee joint Lachman test results had obvious difference （P<0.01）.At final follow-up，all patients had a normal life.10 patients have been strenuous physical activity.All the patients did not have the symptoms of joint lock and joint instability.5 patients had medial knee pain when with squat.Postoperative review of knee joint MRI showed that signal of the posterior horn of the medial meniscus was normal in 31 patients，Ⅱ level signal of the posterior horn of the medial meniscus was in 19 patients and the healing rate of MRI examination was 100%.Conclusion Early arthroscopic treatment knee joint anterior cruciate ligament injury with medial meniscus Ramp injury with satisfactory near future curative effect and is an effective operation，but the long term effect remains to be seen.

[Key words]Arthroscope；Anterior cruciate ligament injury；Medial meniscus Ramp injury

膝关节前交叉韧带（anterior cruciate ligament，ACL）是膝关节当中最为重要的，能够维持静力稳定的结构之一，一旦ACL断裂，将会引起膝关节不稳，导致患者运动水平的下降。ACL损伤后如果未得到及时、有效的处理，将会进一步继发半月板、关节软骨损伤以及关节腔室的改变等内部紊乱[1]。由于内侧半月板其解剖结构的特殊性，因此，膝关节ACL损伤后，如没有得到正确的处理，往往继发膝关节内侧半月板损伤，膝关节内侧半月板后角滑膜缘至关节囊交界区域的纵行撕裂，又称Ramp损伤[2]，是其中较为特异的一种，多见于未得到及时有效处理的、陈旧性、病程较长的ACL损伤。Ramp损伤通过常规的关节镜入路往往难于观察清楚，常常被关节镜医生忽视而忽略治疗，进而导致半月板撕裂加重，甚至导致内侧半月板桶饼样撕裂。造成整个后角的不稳定。因此，关节镜治疗ACL损伤合并内侧半月板Ramp损伤，起到至关重要的作用。……