关节镜外侧半月板下入路技术用于外侧半月板前角层裂下层的切除

Arthroscopic Resection of the Inferior Leaf of the Anterior Horn through Sub-meniscal Route for Horizontal Tear of the Lateral Meniscus

目的探讨关节镜外侧半月板下入路切除外侧半月板前角下层的效果。方法 2008年1月～2010年12月,对10例外侧半月板前角层裂采用关节镜外侧半月板下入路切除外侧半月板前角层裂中不稳定的下层。采用3个入路:膝前外侧入路,前内侧入路及外侧半月板下入路。自前内侧入路置入关节镜观察;经前外侧入路使用探沟翻转层裂上层,并尽可能显露下层;经外侧半月板下入路使用直头Punch(篮钳)切除半月板前角层裂的下层。结果无术后并发症。6例术后MRI检查均显示半月板前角下层完全切除。10例随访12～45个月,平均18.9月:9例膝关节完全不痛,1例偶尔运动后疼痛;10例膝关节活动范围均恢复至正常;膝关节Lysholm评分由术前(68.7±12.9)分提高到术后随访时的(94.4±5.7)分(配对t检验,t=7.79,P=0.00)。结论关节镜外侧半月板下入路可安全、有效切除外侧半月板前角层裂中不稳定的下层。

Objective To evaluate the efficacy of arthroscopic partial meniscectomy via sub-meniscal route for unstable inferior leaf of the anterior horn in horizontal tear of the lateral meniscus. Methods Between January 2008 and December 2010,10 patients with horizontal tear in the anterior horn of the lateral meniscus underwent arthroscopic partial meniscectomy through sub-meniscal route.Three routes,anteromedial,anterolateral,and sub-meniscal route,were employed in our patients.An arthroscope was placed via an anteromedial route,and then the superior leaf of the anterior horn was averted by a probe through the anterolateral route for a better visualization of the lesion.Finally the inferior leaf of the anterior horn was excised with a punch through the sub-meniscal route. Results No postoperative complications occurred in our patients.They were followed up for 12-45 months with a mean of 18.9 months,during which,9 patients had the pain in the knee joints disappeared completely,and the other occasionally had the knee joint pain after doing sports.The flexion range of the knee joints recovered to a normal range in all the 10 patients,and the Lysholm score increased from 68.7±12.9 preoperation to 94.4±5.7（paired t test,t=7.79,P=0.00）. Conclusion Sub-meniscal route provides a safe and effective alternative for resection of the interior leaf of the anterior horn for horizontal tear of the lateral meniscus.