基于解剖测量的Pie-Crusting技术在膝内侧半月板损伤关节镜下治疗中的应用

Anatomical Measurement-Based Pie-Crusting Technique in the Arthroscopic Management of Medial Meniscus Injuries of the Knee

摘要: 目的：通过尸体解剖确定膝关节Pie-crusting技术的松解部位，分析基于此松解部位的Pie-crusting技术在关节镜下治疗膝内侧半月板损伤中的安全性及有效性。方法：解剖实验，通过尸体解剖测量得到膝关节内侧副韧带(MCL)，后斜韧带(POL)的基础数据以及MCL后缘与POL前缘在关节线的水平距离，即Pie-crusting安全距离(PSD)，POL位于膝关节线处的水平长度，即Pie-crusting松解距离(POD)，通过PSD与POD确定膝关节镜Pie-crusting技术的松解部位。临床试验，选取2021年1月1日至2023年10月31日连云港市第一人民医院关节外科60例单纯内侧半月板损伤伴内侧间室狭窄的病人，选择关节镜手术治疗，采用数字随机表法，将病人随机分为三组，每组均为20名患者：即Pie-crusting松解POD治疗组(A组)、常规松解治疗组(B组)和未松解治疗组(C组)。记录三组手术结束前关节软骨医源性损伤发生率及手术时间；采用Lysholm评分与视觉模拟评分(VAS)，记录并比较三组患者术前、术后3天、7天、6周以及末次随访时的膝关节稳定性与患者主观疼痛变化情况。结果：尸体解剖测得POD为15.70 ± 0.90 mm。A组关节镜术后并发症明显低于B、C两组，且手术时间明显缩短；松操作后三组膝关节功能及症状评分在短期内有所降低，但在随访时间内得到了很好的恢复。结论：基于尸体解剖测得的POL的POD松解部位，进行Pie-crusting技术可有效治疗伴有膝内侧间室狭窄的内侧半月板损伤，可缩短手术时间、降低膝关节稳定性下降的风险以及减少医源性关节软骨损伤发生率。

Abstract: Objective: To determine the release site of knee pie-crusting technique by autopsy and analyse the safety and effectiveness of the pie-crusting technique based on this release site in the arthroscopic treatment of medial meniscus injury of the knee. Methods: Anatomical experiments were performed to obtain the basal data of the medial collateral ligament (MCL), posterior oblique ligament (POL), and the horizontal distance between the posterior edge of the MCL and the anterior edge of the POL at the joint line, i.e., pie-crusting Safe Distance (PSD), and the horizontal length of the POL at the joint line, i.e., pie-crusting Operation Distance (POD), based on cadaveric anatomical measurements. The PSD, POD, and the PSD and POD in combination were used to determine the knee arthroscopy pie-crusting technique’s release distance. For the clinical trial, 60 patients with simple medial meniscus injury with medial compartment stenosis at our hospital’s Department of Joint Surgery were selected for arthroscopic surgical treatment from January 1, 2021 to October 31, 2022. The patients were randomly divided into three groups using a random number table system (RNT), with 20 patients in each group: pie-crusting loosening POD treatment group (Group A), conventional loosening treatment group (Group B), and the unloosened treatment group (Group C). The incidence of medically induced damage to articular cartilage before the end of surgery and the duration of surgery were recorded in all three groups. The Lysholm Score and Visual Analogue Scale (VAS) score were used to record and compare the knee stability of all patients pre-operatively; at post-operative 3 days, 7 days, and 6 weeks; and at the time of the final follow-up. Results: The POD was 15.70 ± 0.90 mm. Post-arthroscopic complications were significantly lower in group A than in groups B and C, and the operative time was significantly shorter; knee function and symptom scores were reduced in all three groups in the short term after loosening operation, but were well restored in the follow-up time. Conclusion: Based on the POD release site of the POL measured at autopsy, performing the pie-crusting technique can effectively treat medial meniscus injuries with medial compartment stenosis of the knee, thereby shortening the operative time, reducing the risk of decreased knee stability, and decreasing the incidence of medically induced articular cartilage injury.