误诊为半月板损伤的弹响膝122例分析

Etiological analysis and arthroscopic treatment of snapping knees which were preoperatively misdiagnosed as meniscus injury

目的探讨误诊为半月板损伤患者弹响膝的发生机制、临床表现及诊断,评价关节镜手术疗效。方法122例误诊患者均接受膝关节镜手术,回顾性分析不同病因导致膝关节弹响的部位、响度、发生频率及镜下表现。结果半月板囊肿、盘状半月板、滑膜皱襞、游离体、软骨退变等均可诱发弹响膝,易被误诊为半月板损伤。122例患膝经关节镜手术治疗,112例弹响症状完全消失,10例残余部分症状。术前Lysholm评分(48.5±6.2)分,术后6月(84±5.7)分(P<0.01)。结论不同病因导致的膝关节弹响各有特点,详尽的病史、准确的查体及仔细阅片有助于区分弹响来源,明确诊断,减少误诊误治,提高手术疗效。关节镜诊疗术是诊治弹响膝的金标准。

[Objective] To find out helpful clinical characteristics of snapping knees which were preoperatively misdiagnosed as meniscus injury, and evaluate the effect of arthroscopic treatment. [Methods] 122 cases who underwent arthroscopic treatment were studied retrospectively, all these cases were preoperatively misdiagnosed. [Results] The snapping causes were different from meniscal cyst, discoid meniscus, synovial plica, loose body to cartilage degeneration, which were easily misdiagnosed as meniscus injury. After arthroscopic operation, snapping symptom disappeared in 112 cases, partially remained in 10 cases. Lysholms scoring scale differed from （48.5±6.2） before operation to （84±5.7） after operation （P 〈0.01）. [Conclusion] The characteristics of snapping knees are different depending on different causes. Detailed medical history, exact examination and reading imaging piece can help to distinguish different causes, gain exact diagnosis and prevent mistreatment, at last enhance curative effect. Arthroscopy technology plays an important role in diagnosis and treatment of snapping knees.