关节镜下手术治疗少儿膝关节半月板损伤

Treatment of meniscal tears in children

目的探讨少儿膝关节半月板损伤的膝关节镜下微创手术治疗的特点及其临床效果。方法本组患儿29例,年龄8～16岁(平均11岁)。临床症状:患膝疼痛27例,弹响17例,交锁史13例,膝关节活动受限7例,跛行6例,膝部肿胀3例。膝关节间隙压痛28例,麦氏征阳性27例,MRI检查21例为阳性结果。所有患儿都采用关节镜下手术。术中见半月板边缘撕裂11例,桶柄样撕裂13例,其中撕裂缘嵌顿于髁间窝部5例,前角损伤3例,后角损伤2例。关节镜下半月板部分切除术3例,半月板缝合术26例。半月板缝合术后配戴支具,由专科治疗师行康复治疗。结果本组患儿随访15～182个月(平均38个月),所有患儿术后关节功能恢复正常。1例剧烈活动后时有膝部肿胀,无跛行。Lysolme评分:术前(62±9)分,术后(94±6)分,P<0.01;膝关节功能评分,术前(59±6)分,术后(93±5)分,P<0.01。结论少儿半月板损伤后多表现为交锁和关节活动受限。少儿半月板对膝关节正常功能影响很大,应尽可能采用半月板缝合术治疗。

Objective To review the minimally invasive surgery for meniscal tears in children. Methods Twenty-nine patients with an average age of 11 years （range： 8-16 years） presented with joint pain （n = 27）, audible click （n = 17）, give-away sign （n = 13）,limited range of movement （ROM） （n = 7） ,limp （n = 6） ,swelling （n = 3） ,joint line tenderness （n = 28） ,positive McMuray test （n = 27）, and a positive MRI imaging （n = 21）. They all underwent minimally-invasive surgery. Arthroscopy revealed peripheral tears in 11 patients, ＂bucket handle＂ tears in 13, torn meniscus blocking the femoral condoyle in 5, anterior horn tears in 3, posterior horn tears in 2 patients respectively. Arthroscopic partial meniscectomy was performed in 3 patients and arthroscopic meniscal repair in 26 patients. Post-operatively, the knees were immobilized with a brace and rehabilitation exercise was carried out. Results They were followed-up for 38 months （15-182 months）. Normal ROM of knee was achieved in all patients. One patient had the episodic knee pain triggered by vigorous exercise. Lysolme grade was 62 ± 9 preoperatively and 94 ± 6 postoperatively （P〈0. 01 ）. Knee functional scale was 59 ± 6 preoperatively and 93 ± 5 postoperatively （P〈0. 001 ）. Conclusions The main presentations of meniscal tears in children are limitation of ROM and arrest of knee movement. Synovitis is evident under arthroscopy. Longitudinal and ＂ bucket handle＂ tears are common. Arthroscopic meniscal repair should be adopted. Standard rehabilitation protocol should be carried out by a therapist.