内侧半月板后角“隐匿性”层裂14例报告

Hidden Horizontal Tears of the Posterior Horn of the Medial Meniscus:a Report of 14 Cases

目的探讨内侧半月板后角＂隐匿性＂水平撕裂伤的临床特点及关节镜下半月板部分切除术的临床疗效。方法 2011年5月～2013年5月对14例内侧半月板后角＂隐匿性＂层裂采取膝关节前内、外侧入路关节镜探查,咬除半月板后角内缘后显露层裂,术中探查半月板后角底层不稳,切除底层后行半月板后角成形术。结果术中探查均为内侧半月板后角＂隐匿性＂层裂,6例半月板边缘及上下关节面均完整,8例水平撕裂延伸至胫骨关节面。平均手术时间32 min（26～40min）,平均住院时间6 d（3～8 d）。术后切口均一期愈合,未发生膝关节感染、僵硬等并发症。14例随访2～3年,术后症状缓解,术前Lysholm评分（71.1±6.6）分,术后（92.0±3.4）分,术前后差异有统计学意义（t=10.530,P=0.000）。结论内侧半月板后角＂隐匿性＂层裂主要为退变性破裂,多合并软骨退变损伤,临床诊断较困难,仔细体格检查及MRI对诊断具有指导意义,关节镜下部分切除成形术可改善膝关节功能。

Objective To investigate the clinical features of hidden horizontal tears of the posterior horn of the medial meniscus and clinical efficacy of arthroscopic partical meniscectomy. Methods A total of 14 cases of hidden horizontal tears of posterior horn of the medial meniscus from May 2011 to May 2013 were enrolled. The knee arthroscopy was carried out through anteromedial and anterolateral approaches. The lesion of tears was exposed after the inner edge of posterior horn of the meniscus was bitten away. The bottom of the posterior horn of meniscus was found instable during the operation,which was then removed to conduct a partial meniscectomy. Afterwards the arthroscopic meniscus plasty of the posterior horn was performed. Results Arthroscopic photographs showed normal appearance in 6 cases and tears underside meniscus in 8 cases,all of which were confirmed to be horizontal medial meniscus posterior horn tear during operation. The mean time of operation was 32 min（ range,26- 40 min）,and the mean hospitalization time was 6 days（ range,3- 8 d）. There was no complications,such as infections or stiffnesses. All the patients were followed up for 2- 3 years. Subjective symptoms improved significantly after arthroscopic partial meniscectomy. According to the Lysholm knee scoring scale,the scores were（ 71. 1 ± 6. 6） points preoperatively and（ 92. 0 ± 3. 4） points postoperatively,with significant difference（ t = 10. 530,P = 0. 000）. Conclusion Diagnosis of hidden horizontal tears of the medial meniscus posterior horn is often difficult,because most patients have osteoarthritic knees. Careful physical examination and MRI are critical for making a correct diagnosis. Arthroscopic partial meniscectomy can help patients obtain better results.