盘状半月板损伤105例临床特点分析

A retrospective study of 105 cases with discoid meniscus tear treated by arthroscopy

[目的]探索盘状半月板损伤发病的临床特点及其性别差异、分型、手术方式的相关性等。[方法]选取2000—2012年因盘状半月板损伤就诊的患者105例。统计全部患者的临床症状、盘状半月板Watanabe分型、损伤Bin分型及所采用的手术方式。比较盘状半月板损伤就诊人群中的性别差异，Watanabe分型与损伤类型、症状、手术方式的关系，以及损伤类型与症状、手术方式的差异。[结果]男性与女性的平均就诊年龄为27．2岁和34．7岁（P=0．022），平均病程分别为28．5个月和36．6个月（P=0．415）；临床表现上，有更多的女性前来就诊时有患膝外伤史（P=0．ooo），而在疼痛（P=0．095）、交锁（P：0．313）、伸直受限（P=0．102）、弹响（P=0．838）等方面无统计学差异；根据Watanabe分型，男性就诊患者中完全型较女性少，而不完全型较女性多（P=0．000）；男女性就诊患者的半月板损伤类型（P=0．053）及手术方式（P=0．888）无统计学差异。根据Watanabe分型对所有患者进行分组，各组的Bin损伤分型（P=0．231）、外伤史（P=0．089）、疼痛（P=0．719）、伸直受限（P=0．222）、弹响（P=0．056）及手术方式（P=0．233）无统计学差异，但完全型较不完全型更易出现关节交锁（P=0．007）。根据Bin损伤分型对所有患者进行分组，各组的外伤史（P=0．422）、疼痛（P=0．163）、交锁（P=0．497）、伸直受限（P=0．530）及弹响（P=0．947）无统计学差异，但选择的手术方式具有统计学差异（P=0．001）。[结论]相对于男性就诊患者，女性患者就诊时的年龄更大，且多为Watanabe完全型盘状半月板，提示女性的潜在盘状半月板患者中可能完全型较多，受伤后更易出现临床症状，因此有较高的就诊率。Watanabe不同分型的盘状半月板的发病率存在性别差异。膝关节交锁的出现可能高度提示完全型盘状半月板的可能。仍需进行流行病学普查以进一步明确上述结论。

[ Objective]To analyze the relationship among different clinical symptoms, genders, classifications and type of arthroscopic procedures,in patients with discoid meniscus tear treated by arthroscopy. [ Method ] From 2000 - 2012,105 con- secutive cases were recruited in the study. Clinical symptoms, discoid meniscus classification （ Watanabe）, tear patterns （ Bin classification） and arthroscopic procedures were recorded. Rank- sum test and T test were performed. [ Result] Regarding the differences between different genders,the mean age of the male （37 cases） and female （68 cases） were 27.2 years and 34.7 years respectively （ P = 0.022）. More females would have injury history of the knee （ P = 0.000）, while there were no differ- ences of the incidence of pain （ P = 0.095 ）, locking （ P = 0. 313 ）, extension block （ P = 0. 102 ） and clicking （ P = 0. 838 ）. There were more cases of complete type （ Watanabe＇s classification） while less incomplete type in female （ P = 0.000）, while no differences of tear patterns （ Bin ＂s classification, P = 0. 053 ） and arthroscopic procedures （ P = 0. 888 ）. As to different Watanabe＇s classification, locking of the knee was highly suggestive of the complete type, while no differences were found in other clinical symptoms, tear patterns （ P = 0.231 ） and procedures （ P = 0. 233 ）. In addition, different procedures were performed for different tear patterns （P = 0.001 ）, with clinical symptoms of no statistical differences. [ Conclusion] Compared with the male hospitalized patients, the female were older with higher percentage of complete type, suggesting that the complete type may account for most of the potential female patients ,which was more likely to lead to clinical symptoms after injury of the knee. It could be de- duced that the incidence of different Watanabe＇s classification maybe different in different genders. Blocking of the knee should becontacted with the complete type. These findings could be useful in diagnosis and planning operation, which need further confirmation by epidemiological investigation.