| 王海峰,胡亮,马武秀,等.术中保留黏膜韧带对运动致半月板损伤青年患者关节镜术后恢复的影响.骨科,2026,17(5): 409-416, 426. |
| 术中保留黏膜韧带对运动致半月板损伤青年患者关节镜术后恢复的影响 |
| Effect of intraoperative preservation of the ligamentum mucosum on postoperative recovery after arthroscopy in young patients with sports-related meniscal injuries |
| 投稿时间：2026-04-27 |
| DOI：10.3969/j.issn.1674-8573.2026.05.001 |
| 中文关键词: 半月板损伤 黏膜韧带 关节镜 膝关节功能 本体感觉 重返运动 |
| 英文关键词: Meniscus injury Ligamentum mucosum Arthroscopy Knee function Proprioception Return to sport |
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| 中文摘要: |
| 目的 观察术中保留黏膜韧带对运动致半月板损伤的青年患者术后膝关节功能、本体感觉、运动能力、炎症反应及并发症的影响。方法 采用回顾性队列分析，选取2021年10月至2025年5月因运动致半月板损伤于我院行关节镜下半月板部分切除或缝合手术的98例青年患者为研究对象，根据术中是否保留黏膜韧带，将患者分为保留组（42例）与清除组（56例）。比较两组围手术期指标（手术时间、止血带使用时间、术中出血量、住院时间）、膝关节功能[Lysholm膝关节功能评分、国际膝关节文献委员会（IKDC）主观评分]、静态平衡与本体感觉（单腿闭目站立时间）、肌力恢复情况（30 s坐站测试）、血清炎症指标[白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]及术后并发症发生情况，并评估术后6个月重返运动率、Tegner评分及运动能力恢复水平。进一步按手术方式（仅行半月板部分切除术、半月板缝合术）及伤前运动水平（高水平运动、非高水平运动）进行亚组分析。结果 保留组手术时间、止血带使用时间均长于清除组，术中出血量少于清除组（P<0.05）。术后3个月、6个月时，保留组Lysholm评分、IKDC主观评分、单腿闭目站立时间、30 s坐站测试完成次数及Tegner评分均高于清除组（P<0.05），血清IL-6、TNF-α水平均低于清除组（P<0.05）。术后6个月时，保留组重返运动率高于清除组（66.67% vs. 42.86%，P<0.05），并发症总发生率低于清除组（2.38% vs. 17.86%，P<0.05）。亚组分析显示，采用半月板缝合术的患者中，保留组的重返运动率高于清除组（70.00% vs. 38.24%，P<0.05）；相同运动水平下，保留组术后6个月的Tegner评分高于清除组（P校正<0.025）；相同黏膜韧带处理方式下，高水平运动亚组术后6个月的Tegner评分高于非高水平运动亚组（P校正<0.025）。结论 对于运动致半月板损伤的青年患者，若关节镜术中证实存在无病理改变的黏膜韧带，则建议保留；保留该结构虽可能延长手术时间，但可能减少术中出血量、降低术后并发症发生率及炎症反应水平，并有助于促进术后膝关节功能、静态平衡能力与运动能力的恢复，运动需求较高的青年患者可能获益更为显著。 |
| 英文摘要: |
| Objective To investigate the effects of intraoperative preservation of the ligamentum mucosum on postoperative knee function, proprioception, athletic performance, inflammatory response, and complications in young patients with sports-related meniscal injuries. Methods A retrospective cohort study was conducted. A total of 98 young patients with sports-related meniscal injuries who underwent arthroscopic partial meniscectomy or meniscal repair in our hospital from October 2021 to May 2025 were enrolled. According to whether the ligamentum mucosum was preserved during surgery, the patients were divided into a preservation group (42 cases) and a resection group (56 cases). Perioperative indicators, including operation time, tourniquet time, intraoperative blood loss, and hospital stay, were compared between the two groups. Knee function was assessed using the Lysholm knee score and the International Knee Documentation Committee (IKDC) subjective score. Static balance and proprioception were evaluated by the single-leg blindfolded standing test, and muscle strength recovery was assessed using the 30-second sit-to-stand test. Serum inflammatory markers including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), as well as postoperative complications, were also compared. In addition, the 6-month return-to-sport rate, Tegner score, and athletic recovery level were evaluated. Subgroup analyses were performed according to surgical procedure (isolated partial meniscectomy vs. meniscal repair) and preinjury activity level (high-level exercise vs. non-high-level exercise). Results The operation time and tourniquet time were longer in the preservation group than in the resection group, whereas intraoperative blood loss was lower in the preservation group (P<0.05). At 3 and 6 months postoperatively, the preservation group had significantly higher Lysholm scores, IKDC subjective scores, single-leg blindfolded standing times, number of repetitions in the 30-second sit-to-stand test, and Tegner scores than the resection group (P<0.05), while serum IL-6 and TNF-α levels were significantly lower (P<0.05). At 6 months after surgery, the return-to-sport rate was higher in the preservation group than in the resection group (66.67% vs. 42.86%, P<0.05), and the overall complication rate was lower (2.38% vs. 17.86%, P<0.05). Subgroup analysis showed that, among patients undergoing meniscal repair, the return-to-sport rate was higher in the preservation group than in the resection group (70.00% vs. 38.24%, P<0.05). Under the same level of preinjury activity, the preservation group had a higher 6-month Tegner score than the resection group (Padjusted<0.025). Under the same ligamentum mucosum treatment strategy, the high-level exercise subgroup had a higher 6-month Tegner score than the non-high-level exercise subgroup (Padjusted<0.025). Conclusion In young patients with sports-related meniscal injuries, if a nonpathological ligamentum mucosum is identified during arthroscopy, preservation is recommended. Although preservation may prolong the operation time, it may reduce intraoperative blood loss, lower the incidence of postoperative complications and inflammatory response, and facilitate recovery of postoperative knee function, static balance, and athletic performance. Young patients with higher sports demands may benefit more substantially. |
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