膝关节外侧盘状板损伤的临床特点及关节镜治疗

Clinical features and arthroscopic treatment for discoid lateral meniscus injury

背景：膝关节外侧盘状板损伤是运动损伤中的常见病，有关其关节镜治疗的报道很多，但病例数一般较少，且对其临床特点的研究报道亦少见。 目的：探讨不同年龄组膝关节外侧盘状板损伤的临床特点，以及关节镜治疗的中短期随访结果。 方法：回顾性分析北京协和医院2005年11月至2014年9月行关节镜下盘状板手术、随访超过6个月并有完整病历资料的患者共107例（124膝）。男33例，女74例；年龄9-73岁，平均（40.7±17.5）岁；病程0.5-432个月，平均48.7个月。将患者按照年龄分为两组，A组（≤40岁），50例（54膝）；B组（＞40岁），57例（70膝）。双膝17例，左膝42例，右膝48例。比较两组的临床资料、手术方式，以及术前、末次随访时的VAS评分及Lysholm评分。 结果：随访时间6-84个月，平均（23.2±16.9）个月；末次门诊随访35例，电话随访72例。两组在外伤史、疼痛、肿胀、活动受限、弹响、交锁、打软腿、股四头肌萎缩等病史和临床症状、手术方式以及关节间隙压痛、过伸试验、过屈试验和McMurray征阳性率方面均无统计学差异（P＞0.05），但两组合并软骨损伤的发生率有统计学差异（P＜0.05）。两组末次随访时的VAS评分和Lysholm评分均较术前有明显改善，差异有统计学意义（P＜0.01）。两组术前VAS评分无统计学差异（P＞0.05），但末次随访的VAS评分以及术前和末次随访的Lysholm评分均有统计学差异（P＜0.01）。 结论：盘状板损伤的患者并不一定都有外伤史，疼痛是最主要的临床表现，其次是活动受限。最典型的体征是外侧关节间隙的压痛，其次是McMurray征阳性。关节镜手术可以显著缓解患者的疼痛并改善其功能，但40岁以上患者术后随访时的VAS评分、Lysholm评分均比40岁以下患者的差，这可能是由于更多地合并关节软骨损伤所致。

Background： Discoid lateral meniscus （DLM） injury is a common disorder of the knee. There are many reports on its ar-throscopic treatment, but most of the studies are based on insufficient cases and few of them focus on clinical characteristics. Objective：To explore clinical characteristics of DLM and short-to mid-term clinical outcomes in different age group pa-tients treated by arthroscopy. Methods：A retrospective study was performed in patients who underwent arthroscopic treatment due to DLM from Novem-ber 2005 to September 2014 in our hospital. Eventually, 107 patients with 124 knees who had complete clinical and follow-up information were enrolled in the study. There were 33 males and 74 females with an average age of （40.7 ± 17.5） years （range, 9-73 years）. The average course of disease was 48.7 months （range, 0.5-432 months）. The patients were divided into group A （≤40 years old） and group B （〉40 years old） according to their age. There were 50 cases with 54 knees in group A and 57 cases with 70 knees in group B. There were 17 bilateral DLM, 42 left DLM and 48 right DLM. Clinical data, opera-tive pattern, VAS score and Lysholm score before treatment and at the last follow-up of the two groups were compared. Results：The average follow-up period was （23.2±16.9） months （range, 6-84 months）. The last follow-up was accomplished in 35 cases in out-patient clinic and 72 cases by telephone. There were no statistical difference in terms of injury history, pain, swelling, limitation of movement, snapping, locking of the knee, giving way, atrophy of quadriceps femoris, tender-ness in joint line, hyperextension test, flexion test, McMurray test or surgical patterns between the two groups （P〉0.05）, but the incidence of concomitant injury of cartilage was statistically different between the two groups （P〈0.05）. VAS and Lysholm scores at the final follow-up significantly improved than preoperative ones in both groups （P〈0.01）. No significant＆amp;nbsp;difference was seen in preoperative VAS score of the two groups （P〉0.05）, but significant difference was found in final VAS, preoperative and final Lysholm score between the two groups （P〈0.01）. Conclusions：A history of trauma is not found in each DLM patient. Pain is the most common clinical manifestations, fol-lowed by the limitation of movement. Tenderness in lateral joint space is the most typical sign followed by positive McMur-ray sign. Arthroscopic treatment can significantly reduce the pain of patients and improve their function, but post-operative VAS and Lysholm scores in patients more than 40 years old were poor than those in patients less than 40 years old due to the concomitant cartilage lesion.