关节镜下半月板分区的临床意义

Anatomical Division of the Meniscus for Arthroscopic Suturing

目的探讨关节镜下半月板分区的概念及其对半月板缝合手术操作的指导意义。方法根据关节镜下半月板缝合的临床实践,针对术中操作的特点和规律进行半月板损伤部位的分区:Ⅰ区,前角区;Ⅱ区,前侧方区;Ⅲ区,后侧方区;Ⅳ区,后角区。按照分区方法,Ⅰ区15例,Ⅱ区106例,Ⅲ区36例,Ⅳ区49例。对患者术前与术后的症状改善情况及膝关节功能评分变化进行评估。结果 206例随访25～76个月,平均38个月,膝关节无症状率92.7%(191/206),有临床症状患者的分布:Ⅲ区10例,Ⅱ区1例,Ⅰ区2例,Ⅳ区2例。术前Lysholm评分(52±11)分,显著低于术后(92±8)分(t=-45.153,P=0.000)。多个独立样本比较的Kruskal-Wallis H检验显示各区疗效存在显著性差异(χ2=30.289,P=0.000);组间两两比较的Mann-Whitney U检验显示各区间疗效均存在显著性差异(P<0.05)。结论关节镜下半月板各区缝合具有不同的中期临床疗效,关节镜下半月板分区对指导关节镜下半月板缝合操作具有一定的临床意义。

Objective To introduce the anatomical division of the meniscus by arthroscopy and its significance for arthroscopic meniscal suture.Methods Based on our clinical practice of arthroscopic meniscal suture,we divided the injured meniscus into four areas by the characteristics and rules of the arthroscopic operation： areaⅠ,the anterior horn;area Ⅱ,the anterior lateral region;area Ⅲ,the posterior lateral region;area Ⅳ,the posterior horn.Totally 206 patients with meniscus injury（15 cases had the injury at the area Ⅰ,106 at the area Ⅱ,36 at the area Ⅲ,and 49 at the area Ⅳ）,who received arthroscopic meniscal suture,were enrolled in this study and received evaluation of pre-and postoperative symptoms and the function of the knee joint.Results The patients were followed up for a mean of 38 months（ranged from 25 to 76 months）,during which 191 patients（92.7%） showed no symptoms in the knee joint;the other 15 patients showed symptoms at the area Ⅲ（10 cases）,area Ⅱ（1）,area Ⅰ（2）,and area Ⅳ（2）.Lysholm score increased from 52±11 to 92±8 after the surgery（t=-45.153,P=0.000）.There was significant difference among different areas shown by Kruskal-Wallis H test（χ2=30.289,P=0.000） and significant difference between every two different areas shown by Mann-Whitney U test（P0.008）.Conclusions Meniscus suturing at different areas show different mid-term outcomes.Anatomical division of the meniscus can be used as a guidance for arthroscopic suture of the meniscus.