中老年膝内侧半月板后角放射裂的临床研究

Radial Tears of the Posterior Horn of the Medial Meniscus

目的讨论膝内侧半月板后角放射状撕裂的临床特点和关节镜下半月板部分切除术后的随访结果。方法自2000年6月至2006年6月对386例(418膝)关节镜下治疗的膝内侧半月板撕裂患者进行回顾性研究,其中后角放射状撕裂93膝(22.2%),全部行半月板部分切除术。在详细的手术记录和关节镜图像资料基础上,分析患者术前体征、M R I结果、术中所见和术后Lysho lm膝关节评分。结果中老年患者中膝内侧半月板后角放射状撕裂有较高的发生率,大多数患者表现出机械卡压或撞击症状,M R I很难发现这种撕裂,有特点的疼痛症状和物理检查有助于诊断。虽然大多数患者年龄较大,关节软骨已发生退变,但关节镜下半月板部分切除术后,症状会明显改善。结论膝内侧半月板放射状撕裂比较常见,但因为多数患者同时伴有骨关节炎症状,且M R I上假阴性率较高,诊断比较困难。在严格掌握手术指征下,关节镜下半月板部分切除术有助于改善症状。

Objective To discuss clinical features of radial tears of the posterior horn of the medial meniscus and the following-up results of arthroseopic partial meniscectomy. Methods From June 2000 to June 2006,386 eases（418 knees） of medial meniscal tears treated with arthroseopic surgery were retrospected. Of these, 93 knees （22.2%） were radial tears of the posterior horn. All patients were treated with arthroscopic partial menisceetomy. Based on surgical notes and detailed arthroscopic photographs, we reviewed the preoperative physical signs, results of MRI, surgical findings,and clinical results using the Lysholm Knee Scoring scale. Results Radial tears of the posterior horn Of the medial meniscus was more common than we had known before and also was more common in elderly patients. Most patients presented mechanical symptoms. MRI often failed to reveal the tear. The characteristic of pain and the physical examination was very useful for making the diagnosis. Although most patients were elderly and had degenerated articular cartilages,symptoms improved significantly after arthroscopic partial meniscectomy. Conclusions It is important to note that radial tears of the medial meniscus posterior horn is common. Diagnosis of this tears was often difficult to make because most patients had osteoarthritis and MRI showed unacceptably high rates of false-negative results. Following strict surgical indications, arthroscopic partial meniscectomy could help patients improve their symptoms.