关节镜治疗儿童盘状半月板损伤46例报道

Knee arthroscopic treatment for discoid meniscus in children——46 cases report

目的总结2007年7月至2009年2月采用膝关节镜手术治疗46例儿童盘状半月板损伤的方法和体会。方法全组患者46例,共47膝(1例为双侧先后发病)。其中女28例,男18例,左侧20例,右侧25例,双侧1例。年龄最小6岁,最大15岁,平均10.83岁。所有病例术前均经MRI证实为外侧盘状半月板伴损伤。临床表现:弹跳9膝,交锁6膝,疼痛27膝,伸直受限35膝,股四头肌萎缩32膝,关节线压痛29膝。手术采用脊麻,高位前外侧入路放置4.0mm镜头并作为入水口,高位前内侧入路放置操作器械,必要时添加1～2个辅助工作入路以利于手术操作。术中发现Watanabe分型完全型41例,不完全型4例,Wrisberg韧带型2例。外侧盘状半月板水平裂26例,混合裂15例,斜裂5例,瓣状裂1例。采用碟形手术原则用兰钳及刨削器对盘状半月板行蚕食手术。Wrisberg韧带型2例完全切除,次全切除8例,成形手术37例,将半月板修整成为近乎正常的C形,并保留边缘4mm。术后术前有伸直受限的患儿予长腿直伸石膏筒固定2周后改为膝关节支具,其余患儿术后直接用膝关节支具保护,进行股四头肌肌力训练和膝关节功能锻炼。结果术后半个月、1个月、2个月、3个月、6个月、1年及2年随访,最长随访期2年,最短6个月。术后创伤性关节疼痛3d左右消失,肿胀2周左右消失,关节全方位活动恢复约在术后2～4周,膝关节伸直受限在术后4～6周完全恢复,股四头肌萎缩随之改善。膝关节支具保护8周去除后,患儿恢复日常行走,疼痛、交锁、弹跳症状未再出现,术后半年均投入正常体育活动。无一例发生止血带并发症。结论儿童盘状半月板损伤就诊时多已较重,及时诊疗有助于改善预后。损伤以水平裂多见,关节镜下蝶形成形手术是目前公认最好的治疗手段。根据儿童的特点,应尽可能地使保留的半月板具有正常半月板的形态和功能以防日后关节提早退变。选用合适的器械也有助于手术成功。

Objective To introduce the methods and discuss the results of knee arthroscopic treatment for discord meniscus in children.Methods 46 cases (47 knees) with discord meniscus were treated by knee arthroscopy in our hospital from Jul 2007 to Feb 2009.Age from 6 to 15 years old.20 were left side and 25 were right side.1 was bilateral.All cases were confirmed by MRI.Snap in 9 knees,lock in 6 knees,pain in 27 knees and stiff in 35 knees.41 knees were complete discord meniscus,while 4 were incomplete,and 2 were Wrisberg-type.Most discord meniscus had horizontal cleavage tears.The 2 Wrisberg-type discord meniscus had total resection.8 had partial resection and the others had saucerization.Cast and splint were used after operation.Then began with quadriceps and hamstring strengthening training.Results All cases were followed up at 1,2,3,6,12,24 months after operation.Full range of motion was got 2-4 weeks after operation.8 weeks after operation all patients returned to prior activity.None snap,none pain,none lock reoccur.Conclusions Diagnosis and treatment of the symptomatic discord meniscus in children should begin as early as possible and will improve the prognosis.Often,discord meniscus will have horizontal cleavage tears resulting in a degree of instability.Saucerization has been considered as a method of converting the discord meniscus to a more normal and potentially less problematic shape.Total meniscectomy in children is not a good choice and will result in early osteoarthritis in adult.The equipments which are fit for children are very important to the success of the surgery.