膝关节内侧半月板后根部撕裂的治疗进展

Advances in the treatment of medial meniscus posterior root tear

随着膝骨关节病诊疗技术的不断进步，“阶梯化治疗”和“尽量保留半月板”的理念深入人心。作为维持膝关节内侧半月板环形张力的重要解剖结构，后根部也受到越来越多的关注。后根部撕裂后内侧半月板环形张力丧失，进而导致半月板承载负荷功能部分甚或完全丧失，继发膝关节内侧间隙变窄、软骨退变和膝内翻畸形等骨关节炎改变。对于内侧半月板后根部撕裂的治疗不同学者也持有不同的看法，其治疗方式主要包括保守治疗和手术治疗。保守治疗主要包括非甾体类药物、功能锻炼、物理治疗等。手术治疗主要分为关节镜下内侧半月板部分切除术、关节镜下内侧半月板后根部修复术以及截骨联合关节镜下内侧半月板后根部修复术。尽管保守治疗及部分切除术短期疗效满意，但长期随访显示患膝疼痛、功能及运动水平均无明显改善，而且继发膝关节内侧间室压力及受力面积异常。对于年龄〈65岁、膝内翻〈5°、Outerbridge软骨分级〈Ⅲ级、Kellgren-Lawrence分级〈Ⅲ级患者单纯关节镜下修复术疗效明确，愈合率满意，且可以一定程度上延缓骨关节炎的进程。对于存在关节外畸形（胫骨近端内侧角〈85°或股骨远端外侧角〉90°）、膝内翻〉5°力线不良患者，截骨术可有效改善临床疗效，是否一期联合关节镜下内侧半月板后根部修复术尚存在争议。

With the continuous progress of diagnosis and treatment technology on knee osteoarthrosis, the concept of ＂stepwise treatment＂ and ＂keeping meniseus as much as possible＂ has been deeply rooted in people＇s minds. As an important anatomical structure for maintaining the annular tension of the medial meniscus of the knee, more and more attention has been paid to the posterior root. After the root tear of the medial meniscus, the annular tension loss, leading to the meniscus bearing load func- tion partial or complete loss, and secondary knee medial space narrow, cartilage degeneration and genu varus deformity. In the treatment of root tear of the medial meniscus different scholars hold different views. The treatment of the medial meniscus posterior root tear of the knee is mainly conservative treatment and operative treatment, and the conservative treatment mainly includes non-steroidal drugs, functional exercise, physical therapy, and so on. The surgical treatment mainly included the medial meniscus partial resection of the medial meniscus under the arthroscope, the medial meniscus posterior root repair under the arthroseopy, and osteotomy with medial meniseus posterior root repair under the arthroscopy. Despite the short-term curative effect of conservative therapy and resection is satisfied, long-term follow-up has no obvious improvement with knee pain, function and activity levels, and causes secondary biomechanieal change of knee. For patients of age 〈65, genu varus 〈5°, Outerbridge cartilage classifica- tion 〈 grade Ⅲ and grade of Kellgren-Lawrenee 〈 level Ⅲ, the curative effect of medial meniscus posterior root repair under the arthroseopy is satisfied, with good healing rate, and can delay the process of osteoarthritis in certain degree. For patients with joint deformities （medial proximal tibial angle 〈 85°/lateral distal femur angle 〉90°） genu varus 〉5°, nsteotomy can effectively improve the clinical curative effect. However, whether to repair the medial meniscus posterior root together is still controversial.