Wrisberg韧带型盘状半月板的诊断与治疗

DiagnosisandTreatmentoftheWrisbergLigamentTypedDiscoidMeniscus

１９９０年２月～１９９４年９月我院做膝关节镜检１７６膝，有６膝确诊为Ｗｒｉｓｂｅｒｇ韧带型盘状半月板（ｗｒｉｓｂｅｒｇｌｉｇａｍｅｎｔｔｙｐｅｄｄｉｓｃｏｉｄｍｅｎｉｓｃｕｓ，简称ＷＬＤＭ），占３．４％．患者均因膝关节弹响、疼痛入院．查体发现膝关节屈伸弹跳征阳性．镜视下见半月板后角增厚肥大，与胫骨和关节囊无附着，板股韧带短而粗．６例ＷＬＤＭ中３例做半月板成形术，术后疗效不满意；另３例做半月板全切，术后弹响症状消失．对少年期出现膝关节弹响，膝关节屈伸弹跳征阳性患者应考虑ＷＬＤＭ，确诊需做膝关节镜检查．ＷＬＤＭ不宜单纯做半月板成形术．

Onehundredandfifty-twopatientsunderwentarthroscopyof176kneesbetweenFebru-ary1990andSeptember1994werereviewed.SixkneesinfourpatientshadWrisbergligamenttypeddis-coidmeniscus(WLDM),accountingfor3.4%ofthetotalnumberofjointsexamined.these4patientswereadmittedbecauseofsnapandpainintheirknees.Clinicalexaminationshowedasignofslowadduc-tionandrapidabductionofthetibiaassociatedwithasnap;theso-caled“jumpingsign”canbeelicitedwhenthekneewaspassivelymovedto10～15degreesofflexion.Arthroscopyrevealedhapertrophyandthickeningoftheposteriorhornsexhibitingaroughsurface,devoidofatachmenttothetibiaandthejointcapsule.Instead,therewasonlyoneattachmenttothemeniscofemoralligament.Partialarthroscop-icmeniscectomywasdonein3kneesresultinginapproximatelynormalperipheralrims;however,there-sultswerepoor.Theremaining3kneesweretreatedbytotalarthroscopicmeniscectomyandthesnapdisappearedafteroperation.SnapsignofWLDMusualybegintoappearatjuvenileperiodandthe“Jumpingsign”isaspecialclinicalfeatureofthiscondition.Arthroscopyisnecessarytoconfirmthedi-agnosis.Theappropriatetreatmentofthisconditionistotalmeniscectomy.