关节镜下半月板部分切除术治疗膝关节半月板损伤的疗效观察

Arthroscopic meniscus partial resection in treatment of knee meniscus injury

目的探讨关节镜下半月板部分切除术治疗膝关节半月板损伤疗效,并与半月板成形术、保守治疗比较。方法回顾性分析2012年9月-2015年9月该院95例膝关节半月板损伤患者的临床资料,根据治疗方案分为3组,半月板部分切除术组(37例)行关节镜下半月板部分切除术,半月板成形术组(30例)行关节镜下半月板成形术,保守治疗组(28例)拒绝手术患者给予保守治疗。治疗后6个月评估临床疗效;治疗后6个月和2年采用L-ROM测定评估膝关节活动度,发放视觉模拟评分(VAS)评估患者疼痛程度,发放Lysholm膝关节功能评分评估膝关节功能,记录3组远期并发症发生。结果半月板部分切除组治疗总有效率为97.30%和半月板成形术组的86.68%均高于保守治疗的53.57%(P<0.05),半月板部分切除术组与半月板成形术组组间比较无差异(P>0.05);与治疗前相比,3组患者治疗6个月、2年后膝关节活动度、Lysholm评分明显上升,VAS评分明显下降(P<0.05),半月板部分切除术组、半月板成形术组治疗6个月、2年后膝关节活动度、VAS评分组间比较无差异(P>0.05),但与保守治疗组比较差异明显(P<0.05);半月板部分切除术组治疗6个月、2年后Lysholm评分明显高于半月板成形术组、保守治疗组(P<0.05),半月板成形术组、保守治疗组组间比较有差异(P<0.05)。结论关节镜手术治疗膝关节半月板损伤效果确切,且关节镜下半月板部分切除在改善膝关节功能上更具优势。

Objective To explore the effect of meniscus partial excision under arthroscopy for meniscusinjury of knee joint, and compare it with meniscus plasty and conservative treatment. Methods The clinicaldata of 95 patients with meniscus injury of knee joint from September 2012 to September 2015 were analyzedretrospectively. According to the treatment plan, the patients were divided into partial meniscectomy group （37cases）, meniscus angioplasty group （30 cases） and conservative treatment group （28 cases）. After 6 months oftreatment, the clinical curative effect was evaluated. After 6 months and 2 years of treatment, L-ROM was used tomeasure the range of motion, and the visual analogue scale （VAS） was used to evaluate the pain degree. The kneefunction score （Lysholm） was issued to evaluate knee function. The incidence rates of long-term complications in the three groups were recorded. Results The total response rate in partial meniscectomy group （97.30%） andmeniscus angioplasty group （86.68%） were higher than conservative treatment group （53.57%） （P 〈 0.05）. Therewas no significant difference between partial meniscectomy group and meniscus angioplasty group （P 〉 0.05）;After 6 months and 2 years of treatment, the knee range of motion and Lysholm scores of the three groups weresignificantly higher than those before treatment while VAS scores were significantly lower （P 〈 0.05）. However, therewere no significant differences between partial meniscectomy group and meniscus angioplasty group （P 〉 0.05） butthere was significant difference, compared with conservative treatment group （P 〈 0.05）. Lysholm scores of partialmeniscectomy group were significantly higher than meniscus angioplasty group and conservative treatment group（P 〈 0.05）, and there was significant difference between meniscus angioplasty group and conservative treatmentgroup （P 〈 0.05）. Conclusion The effect of arthroscopic surgery in the treatment of meniscus injury of knee joint isaccurate. Arthroscopic partial meniscectomy has more advantages in improving the knee function.