膝关节内侧盘状软骨损伤13例病历分析

Clinical Analysis of 13 Cases with Discoid Medial Meniscus Injury

目的：回顾性研究13例膝关节内侧盘状软骨损伤患者（随访11例）的临床表现和手术治疗效果。方法：对我所收治的13例内侧盘状软骨损伤患者的临床特征、手术方式、治疗效果和影像学改变等进行评估，并结合文献进行分析。结果：内侧盘状软骨损伤占全部半月板损伤的1．35％。，男性多见。内侧盘状软骨分为完全型和不完全型两种类型。损伤发生年龄平均为（28．8±14．0）岁，损伤机制多为屈膝内旋损伤，损伤类型以纵裂和层裂多见。临床症状以疼痛、肿胀、弹响和打软为主，体征以内侧关节间隙压痛最为典型。手术以盘状软骨切除为主，近期效果良好：术后2年的Tegner评分为7（4～9）分，Lysholin评分为94．8±2．4。远期效果由于内侧关节间室退变而变差。结论：内侧盘状软骨损伤少见，临床特征同一般半月板损伤，无特异性表现。盘状软骨切除近期效果良好，远期效果由于内侧关节间室的退变而逐渐变差。

Abstract Purpose To present the clinical manifestations and the outcomes of surgical treatments of 13 patients（ll of them were followed up） with discoid medial meniscal injury. Methods The epidemiol- ogy,clinical manifestations,operation methods,treatment outcome and radiographic characteristics of 13 patients with discoid medial meniscal injury was reviewed retrospectively. Results The incidence of dis- coid medial meniscal injury （including complete and incomplete types） accounted for 1.35%o of the total meniscus injuries,and most of the patients were male. The average age of the patients with injury of the discoid medial meniscus was 28.8±14.0 years old. The majority of meniscal tears （longitudinal or hori- zontal tear） was caused by extreme internal rotation at knee flexion. The most common clinical symptoms and signs included pain, effusion, snap and clicking, and tenderness at the medial joint line. Total menis- cectomy was performed in these patients. Tegner score and the Lysholm score at 2-year follow up were 7 （4 to 9） and 94.8±2.4,respectively. However,long-term follow-up revealed degenerative changes in the medial compartment of all the involved knees. Conclusion The discoid medial meniscal injury occurs rarely. The clinical signs and symptoms of discoid medial menical injuries are similar to those of any other meniscal injury. Meniscectomy for injured discoid medial meniscus produces promising short-termresults, and thereafter gradually causes secondary degeneration of cartilage in the medial compartment.