成人有症状外侧盘状半月板的关节镜治疗及MRI分型

Arthroscopic treatment and MRI classification for symptomatic discoid lateral meniscus in adults

目的探讨成人有症状外侧盘状半月板(DLM)的关节镜治疗疗效及其MRI分型。方法 2009年1月至2010年4月共连续收治58例成人有症状DLM患者。其中男27例,女31例,年龄18～67岁,平均(30.3±12.4)岁。左膝关节30例,右膝关节14例,双膝关节14例。对所有有症状DLM的70个膝关节及非盘状半月板的2个膝关节进行了关节镜手术,其中DLM部分切除+成形30个膝关节(42.86%),DLM次全切40个膝关节(57.14%)。根据Lysholm及IKDC主观评分标准进行膝关节功能评估。同时对有症状DLM进行MRI分型。结果术后随访时间18～24个月,平均(23.07±3.62)个月。末次随访时,所有患者膝关节疼痛及肿胀症状均消失或明显减轻,活动度恢复正常。均未发生伤口或关节感染等并发症。Lysholm、IKDC主观评分分别为(95.69±3.69)分、(94.76±3.76)分,与术前比较均有统计学差异。所有70个膝关节有症状DLM的MRI分型如下:无移位45个膝关节,前向移位2个膝关节,后向移位11个膝关节,中央移位12个膝关节。结论关节镜手术治疗成人有症状DLM创伤小,疗效显著。成人有症状DLM的MRI分型中无移位型最常见,占64.29%;而前向移位型最少见,仅占0.03%。

Objective To discuss the outcome of arthroscopic treatment and MRI classification for symptomatic discoid lateral meniscus(DLM)in adults.Methods From January 2009 to April 2010,58 consecutive adult patients with symptomatic DLM underwent arthroscopic surgery at our clinical center.There were 27 males and 31 females with a mean age of (30.3±12.4) years(range,18 to 67 years).30 menisci occurred on left knee and 14 on right knee.14 had bilateral knee involvement.The arthroscopic surgery were performed to 70 knees for symptomatic DLM and 2 knees for torn lateral menisci but not DLM.Among 70 knees for symptomatic DLM,partial meniscectomy and saucerization were performed in 30 knees(42.86%)and subtotal meniscectomy were done in 40 knee(57.14%).The patients were evaluated according to Lysholm and IKDC rating scales.MRI findings of symptomatic DLM were classified based on peripheral attachment.Results All patients were followed up for more than 18 months at an average period of (23.07±3.62) months.At the last follow-up,all patients had progress in pain,swelling and range of motion of the knees.No complication,which included wound or intraarticular infection,was found.Post-operative Lysholm and IKDC subjective scores were 95.69±3.69 and 94.76±3.76 respectively,significant statistical difference was found compare to the pre-operative results(P<0.001).MRI classifications of symptomatic DLM in adults include the following 4 types:no shift(45 knees),anterocentral shift(2 knees),posterocentral shift(11 knees),and central shift(12 knees).Conclusions As the treatment of symptomatic DLM in adults,arthroscopic surgery showes the advantages of providing minimally invasive and getting significant curative effects.Among the MRI classifications,no-shift-type is the most common,accounts for 64.29%;anterocentral-shift-type is the most rare,only accounts for 0.03%.