膝关节半月板损伤与组织及功能重建

Injury of the knee meniscus and its functional repair

目的:膝关节半月板损伤是运动损伤中常见的一种损伤,半月板切除将导致膝关节退行性关节炎这一问题已引起了医学界的关注,主要原因是产生膝关节负荷传导紊乱。对膝关节半月板损伤机制及治疗方法的研究进展进行综述,总结了膝关节半月板损伤的各种治疗方案,以供医疗人员选择更加适当的治疗方法。资料来源:应用计算机检索PubMed、中国期刊全文数据库、万方数据库1994-01/2005-04期间的相关文章,检索词分别为“menisci injuries,knee injuries”和“膝关节半月板损伤、膝关节研究进展”。资料选择:对资料进行初审,纳入标准:①有关节膝关节半月板的基础研究。②有关膝关节半月板损伤的研究。③有关膝关节损伤治疗的研究。排除标准:个案报道及统计学上可信性较低的文章。资料提炼:共收集到84篇有关膝关节损伤的文章,排除重复或类似的同一研究,30篇符合研究要求(其中11篇为膝关节半月板的基础研究,10篇为有关膝关节半月板损伤的研究进展方面的文献,9篇涉及膝关节半月板损伤治疗方面的研究)。资料综合:①膝关节半月板的基础研究:包括男性膝关节等速向心收缩正常值研究,体育运动引起膝关节劳损的因素及预防的研究:从膝关节在运动过程中通过环节的屈伸完成各种承负功能分析膝关节半月板的损伤;膝关节半月板的形态学研究进展及其临床意义,膝关节半月板损伤的研究进展;从膝关节的解剖学因素分析膝关节受力对半月的影响。②有关膝关节半月板损伤的研究进展:包括骨髓基质细胞移植修复半月板无血运区损伤的实验研究,膝关节半月板损伤的MRI诊断,兔半月板软骨组织缺损的体外修复实验,提出半月板损伤的治疗思路;总结了膝关节半月板损伤在治疗方法上的一些问题,即促使裂伤半月板的愈合、建立血管通道、滑膜刮擦、外源性纤维蛋白凝块的植入、生长因子等方法。结论:膝关节半月板损伤的发生与其解剖结构有密切的关系,在多种运动项目中容易发生。半月板切除将导致膝关节退行性关节炎这一问题已引起了医学界的关注,主要原因是产生膝关节负荷传导紊乱。半月板损伤的治疗目的,除了改善临床症状外,更主要的则是保存原有半月板的功能。然而如何实现这一目的,国内外骨科界正在积极研究探讨中。

OBJECTIVE： Meniscus injury is a common problem in sports injury. Doctors have emphasized the degenerative arthritis of knee caused by weight bearing conducting disturbance after meniscus excision, in this paper, we reviewed the research about the progress in the mechanism and treatment of meniscus injury and summarized the therapies for meniscus injury to provide better therapy plans for doctors. DATA SOURCES： A computer-based online search of Pubmed, CJFD and Wanfang database was undertaken to identify the related Chinese articles published from January 1994 to April 2005 with the key words of ＂meniscus injury, knee injuries＇. STUDY SELECTION： The data were selected firstly. Inclusive criteria： ①fundamental study about meniscus of knee; ② study on meniscus injury; ③research on the treatment of meniscus injury. Exclusive criteria： individual case report and articles not statistically reliable. DATA EXTRACTION： Totally 84 articles about knee injury were collected, after excluded the repetitive or similar studies, 30 articles were included, of which there were 11 fundamental studies about the meniscus of knee, 10 about the research progress of meniscus injury, and 9 about the treatment. DATA SYNTHESIS： ①Fundamental study on meniscus of knee includes the normal value of concentric contraction of knee with constant speed in men, the factors causing fatigue of knee in sports and its prophylaxis, analysis of knee injury in different stages of stress bearing during its movement, morphological study progress of meniscus and its clinical implication, latest achievement on meniscus injury, and the relationship between anatomy and the influences of menisci during knee movement. ②Study improvement on menisci injury includes the experimental study on transplanting bone marrow stroma cells into injured avascular area of menisci, MRI diagnosis of meniscus injury, in vitro repair of rabbit menisci defect, which showed some new tries in treatment. Some aspects about treatment were mentioned such as stimulation of menisci healing, foundation of vascularity, influence of synovial membrane, implanting of exogenous fibrin clot and growth factors. CONCLUSION： Menisci injury is very common in sports, and has a close relationship with its anatomy structure; Doctors have emphasized the degenerative arthritis of knee caused by weight bearing conducting disturbance after meniscus excision. Treatment of menisci injury could improve the clinical symptoms, and more importantly, it could preserve the original function of menisci. However, it is under discussion in the orthopedics field at home and abroad.