同种异体半月板移植和半月板切除术后中期临床效果比较

Comparison of Mid-term Clinical Outcome of Meniscus Allograft Transplantation and Meniscectomy

目的：比较同种异体半月板移植和半月板切除术后中期临床效果。方法：2005年6月至2009年8月,16例半月板切除术后患者接受18个同种异体半月板移植（移植组）,其中男12例,女6例,年龄25.7±7.9岁。以同期行半月板切除术的20例患者为对照（切除组）,其中男12例,女8例,年龄25.0±7.2岁。采用IKDC评分、Lysholom评分、Tegner评分、VAS评分等比较两组患者临床效果,并通过X线、核磁共振成像（MRI）比较两组患者膝关节退变和软骨损伤进展情况。结果：两组平均随访时间分别为60±20、54.4±6.1个月,术前IKDC评分、Lysholom评分、Tegner评分、VAS评分无显著性差异。术后两组患者的临床评分、单腿跳、关节间隙变化和力线等无显著性差异。切除组Kellgren-Laurence分级术后与术前的差值为1.4（1～2）,明显高于移植组的0.3（0～1）（P〈0.05）。移植组术后MRI软骨分级和软骨损伤进展程度均明显低于切除组,分别为1.2（0～3）vs 2.0（1～3）（P=0.028）,0.7（0～2）vs 1.4（0～2）（P=0.001）。结论：半月板移植术后中期临床效果良好,与半月板切除无明显差异;半月板移植具有保护软骨、减缓关节退变的作用。

Objective To compare the mid-term clinical outcomes of meniscal allograft transplantation and meniscectomy. Methods Between June 2005 and August 2009 in our hospital, 18 meniscus allografts were transplanted to 16 patients（12 male and 6 females）,aged 25.7 ± 7.9 years（transplantation group）and 20patients（12 male and 8 females）received meniscectomy,aged 25.0 ± 7.2 years（meniscectomy group）. The IKDC score, Lysholm score, Tegner score and VAS score were compared between the two groups. X-ray and MRI were used to evaluate the degree of knee joint degeneration and the chondral lesions. Results The follow-up durations of the two groups were 60 ± 20 months and 54.4 ± 6.1 months respectively. There was no significant difference in preoperative IKDC score, Lysholm score, Tegner score and VAS score,as well as in postoperative clinical scores, one leg jumping, changes of the joint space and alignment between the two groups. Pre-post cartilage degeneration（Kellgren-Laurence score）on X-ray in transplantation group was Less than in meniscectomy group [1.4（1--2）vs 0.3（0--1）, P〈0.05],as well as the postoperative Yulish score [1.2（0--3）vs 2.0（1--3）,P = 0.028] and the pre-post Yulish score changes on MRI [0.7（0--2）vs1.4（0--2）,P =0.001]. Conclusion Though the meniscus allograft transplantation were satisfied with better chondroprotection and retard of joint degeneration,however,the mid-term clinical results of the two groups were similar.