部分切除和边缘缝合术治疗外侧盘状半月板损伤

Arthroscopy assisted partial meniscectomy and repair for torn discoid lateral meniscus

[目的]观察关节镜下部分切除和边缘缝合术治疗外侧盘状半月板损伤的必要性及临床疗效。[方法]2006年1月～2009年6月,共收治32例外侧盘状软骨损伤,男13例,女19例;平均年龄27岁(15～51岁);术前均主诉膝外侧疼痛或活动受限,McMurray试验阳性,经MRI证实外侧盘状半月板损伤。所有病例均经关节镜检查证实,关节镜下切除盘状半月板中央部的白区部分,修整呈正常的半月板形状后,采用由外向内法或全内缝合法缝合撕裂的半月板边缘部分。27例患者得到随访,平均随访17个月(13～22个月),以最后一次随访的Lysholm膝关节评分评价手术前后膝关节功能。[结果](1)32例均有盘状半月板中央部白区的撕裂,前角边缘撕裂23例,体部边缘撕裂19例,后角边缘撕裂8例;(2)本组单纯部分切除成形术者仅4例,其余28例均同时进行了边缘缝合;(3)随访的27例患者术后关节疼痛及活动受限的症状均得到缓解,McMurray试验阴性;(4)术后最后一次随访的Lysholm评分从术前平均47分(32～65分)提高到平均88分(75～98分),根据改良的Lysholm膝关节分级标准,优19例,良5例,可3例,优良率达88.9%。[结论]外侧盘状半月板损伤常存在边缘撕裂,成形后应注意辨别,缝合撕裂的盘状半月板边缘有利于术后外侧半月板结构的稳定。

[Objective]To observe the necessity and outcome of arthroscopic partial resection and marginal repair for discoid lateral meniscus tear.[Method]From January 2006 to June 2009,32 patients with torn discoid lateral meniscus were treated,including 13 males and 19 females,with an average age of 27 years（15 to 51 years）.All cases complained pain on the lateral side of injured knee,and were confirmed as discoid lateral meniscus injury by positive McMurry test,MR image,and arthroscopic observation.After meniscal plasty by resection of injured central part,marginal repair was completed by outside-in or all-inside technique.Twenty-seven patients were followed up for an average of 17 months（13 to 22 months）,and were evaluated by Lysholm knee score at the last follow-up.[Result]（1） In this group,there were tears in central white zone in all 32 cases,and marginal tears at anterior horn in 23 cases,at body in 19 cases,and at posterior horn in 8 cases.（2） The symptoms were relieved in all 27 followed up patients,in whom the McMurry test was negative postoperatively.（3） At the last follow-up,the average Lysholm knee score improved from 47（range,32-65） to 88（range,72-98）.[Conclusion]The marginal tear was common in injured discoid lateral meniscus,need to identify and repair during surgery after meniscal plasty,which would contribute to the stability of lateral meniscus postoperatively.