膝关节半月板硬结变性损伤的临床与病理表现

Clinic and pathology of the knee menisci injury with sclerosis denaturalization

目的:总结半月板硬结变性损伤的临床与病理特点,并对这种硬结的形成机制和临床意义进行初步探讨。方法:回顾性分析1989至2003年本科收治的半月板硬结变性损伤诊治及康复情况。组织切片观察半月板硬结变性部分的组织学变化。结果:半月板硬结变性损伤125个,占24.1%,其中77.6%属单纯硬结变性损伤,其临床表现不典型,多仅有膝痛、关节间隙压痛,关节镜下半月板形态完整,表面微隆、色暗、欠光滑及有弹动感。病理表现为半月板局部硬结形成,组织学改变主要表现为纤维组织增生、玻璃样变及黏液样变。保守治疗有一定疗效,切除硬结变性的半月板能够消除症状。结论:单纯半月板硬结变性损伤临床表现不典型,关节镜检查有助于明确诊断。对病程长、症状重的晚期病例可考虑手术切除。

Objective To summarize the characteristics of clinic and pathology of the knee menisci injury with sclerosis denaturalization and to discuss the mechanism of the sclerosis and its clinic significance. Methods We retrospectively analyzed the diagnosis and treatment and healing of the knee menisci with the sclerosis denatured injury from 1989 to 2003. The changes of the partial meniscus with sclerosis denaturalization were observed in tissue section. Results Menisci with sclerosis denaturalization occupied 24.1%, and 77.6% of them subordinated to simple sclerosis denaturalization without tear. Their characteristics were that the manifestations were not except typical knee pain, tenderness at joint line,integrity shape with dull or less lubricity and tiny grand on the super face of menisci under the arthroscopy, and trembles could be touched by a probe. Pathology showed the formation of local sclerosis with the histological changes of fibro-hyperplasia, hyaline degeneration and mucous degeneration in the menisci. No operation obtained curative effects. Symptoms can be eliminated by the excision of the menisci with sclerosis denaturalization. Conclusion The clinic of simple meniscus injury with sclerosis denaturalization are non-typical and arthroscopic check-up is valuable for the diagnosis. The menisci can be removed from the patients suffered from heavy symptoms for a long time.