关节镜下治疗膝关节外侧盘状半月板损伤的临床疗效

EFFECTIVENESS OF ARTHROSCOPIC TREATMENT FOR LATERAL DISCOID MENISCUS INJURIES

目的探讨关节镜下治疗膝关节外侧盘状半月板损伤的方法及近期疗效。方法 2010年1月-2011年5月,收治38例(42膝)外侧盘状半月板损伤患者。男23例(24膝),女15例(18膝);年龄7～62岁,中位年龄32.8岁。病程7 d～40年,中位病程8.6个月。根据Watanabe盘状半月板分型标准,完全型22膝,不完全型19膝,Wrisberg型1膝。于关节镜下行半月板成形联合缝合术25例(28膝),半月板次全切除术12例(13膝),半月板全切除术1例(1膝)。术后早期开始肌力训练和关节活动练习。结果术后切口均Ⅰ期愈合。患者3～4周基本恢复正常活动。38例均获随访,随访时间12～18个月,平均14.3个月。无关节交锁及弹响症状;未出现再撕裂或因症状复发再手术的患者。术后3、6个月及1年膝关节屈曲及伸直活动范围均较术前显著改善(P<0.05);术后1年手术疗效按照Ikeuchi的评价方法,获优22膝,良16膝,可4膝,优良率为90.4%。术前及术后即刻、3、6个月、1年的Lysholm评分分别为(69.38±4.59)、(88.57±2.95)、(91.02±4.17)、(92.90±3.36)、(94.74±3.52)分,术后各时间点评分均较术前显著改善(P<0.05)。结论关节镜下治疗外侧盘状半月板损伤创伤小,能够精确切除或缝合失稳及破裂的半月板,最大限度保留半月板功能,延缓膝关节退变,术后配合正规康复训练可获得良好近期疗效。

Objective To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury. Methods Between January 2010 and May 2011, 38 patients （42 knees） with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males （24 knees） and 15 females （18 knees）, aged 7-62 years （median, 32.8 years）. The disease duration was 7 days to 40 years （median, 8.6 months）. According to Watanabe＇s classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients （28 knees）, partial meniscectomy in 12 patients （13 knees）, and complete meniscectomy in 1 patient （1 knee）. After operation, the rehabilitation training programs （including straight-leg-raising exercise and range of motion exercise） were carried out. Results All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months （mean, 14.5 months）. No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation （P 〈 0.05）. Based on Ikeuchi＇s grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 ＋ 2.95 at immediate, 91.02 ＋ 4.17 at 3 months, 92.90 _＋ 3.36 at 6 months, and 94.74 _＋ 3.52 at 12 months after operation from 69.38 __ 4.59 before operation （P 〈 0.05）. Conclusion Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.