正常形态半月板与盘状半月板损伤关节镜下分型修复的特点:同期对照比较

Injury classification of natural meniscus and discoid meniscus in arthroscopy:A concurrent controlled trial

目的:盘状半月板是因半月板的宽度和高度异常增大呈盘状而得名。观察正常形态半月板与盘状半月板损伤镜下分型及特点,对比关节镜治疗的术后疗效。方法:⑴试验对象:选择2001-06/2006-09安徽医科大学第一附属医院膝半月板损伤的患者360例,其中正常半月板损伤组300例,盘状半月板损伤组60例,均为外侧盘状半月板。纳入标准:①术前临床资料完整。②经关节镜下证实。③术后随访资料齐全。④患者对治疗知情同意,并在手术前签订知情同意书。⑵试验方法:关节镜下探查300例正常形态半月板及60例盘状半月板的损伤情况,根据不同损伤类型按术中情况分别予成形术、部分切除、次全切除和全切除。⑶试验评估:随访6个月至2年,按Ikeuchi氏膝关节评价等级评定膝关节的功能。结果:纳入正常半月板损伤300例及盘状半月板损伤60例,均进入结果分析。①正常半月板最多的损伤类型是纵裂占43.7%,放射状裂占30%,水平裂占12.3%,横裂占7.5%,混合裂占6.5%;盘状半月板发现水平裂占68.3%,放射状裂占6.7%,纵裂占3.3%,混合裂占21.7%。②根据镜下确定半月板损伤类型决定手术方式,所有患者均获得随访,300例正常半月板损伤患者中优62例,良190例,可34例,差14例,优良率占85%;60例盘状半月板损伤患者中优19例,良34例,可5例,差2例,优良率约占90%。结论:盘状半月板损伤的类型因其解剖特征和组织学构成与正常形态半月板不同,关节镜下治疗的方法也有区别。

AIM： Discoid meniscus is named because its width and height are abnormally increased like a disc. In this study, we observed the injury classification and special features of discoid meniscus and natural meniscus, and compare the postoperative outcome of arthroscopy comparatively. METHODS： ①360 cases of meniscus injury in knee joint were selected from the First Affiliated Hospital of Anhui Medical University from June 2001 to September 2006. They were divided into natural meniscus injury group （n =300）, and discoid lateral meniscus injury （n =60）. People with complete clinical data before operation and following data, confirmed by arthroscopy were selected. The written informed consent was obtained from them. ②Meniscus injury in 360 cases was examined by arthroscopy, and plasty, or partial excision or incomplete resection or full resection was performed according to the injury types and surgical circumstance. ③All subjects were followed for 6 months to 2 years. The knee function was evaluated by the criteria of Ikeuchi. RESULTS： 300 cases of natural meniscus injury and 60 of discoid lateral meniscus injury were all included in the result analysis. ①Five tear types of natural meniscus were as follows： 43.7% longitudinal, 30% radial, 12.3% horizontal, 7.5% transverse, and 6.5% complex. Four tear types of discoid meniscus were as follows： 68.3% horizontal, 6.7% radial, 3.3% longitudinal, and 21.7% complex tear. ②The surgical pattern was determined by the injury types, and all patients were followed up. In 300 cases of natural meniscus, there were 62 knees with excellent function, 190 with good, 34 with fair and 14 with poor. The excellent and good rate was 85%. In 60 cases of discoid meniscus, there were 19 knees with excellent function, 34 with good, 5 with fair and 2 with poor. The excellent and good rate was 90% approximately. CONCLUSION： Discoid meniscus is different in anatomical feature and histological structure from natural meniscus; therefore the arthroscopic surgery for discoid meniscus is also different.