外侧盘状半月板成形术对早期骨关节炎的疗效观察

Effect of lateral discoid meniscus plasty on early osteoarthritis

目的探讨外侧盘状半月板(DLM)成形术对早期骨关节炎(OA)的影响。方法①治疗组:对30例32膝有症状的DLM患者行关节镜下DLM成形术;②对照组:对26例28膝有症状的DLM患者,行关节镜下DLM次全切术;③选取治疗前、治疗开始至第20周、治疗后2年3个时间点,观察两组的视觉模拟评分(VAS)、McMurray试验、X线(负重正位)股胫角(FTA)、膝关节磁共振成像(MRI)软骨损伤分级和Harris评分,对两组数据行不同时间点的组间及组内比较。结果治疗组Harris膝关节功能评分术前41~89(61.87±10.75)分,术后2年随访时79~96(88.43±3.99)分,术前和术后比较,差异有统计学意义(P <0.05)。对照组Harris膝关节功能评分术前50~86(61.67±8.47)分,术后2年随访时75~95(85.76±4.74)分,术前和术后比较,差异有统计学意义(P <0.05)。随访结束时,治疗组膝关节功能优于对照组,差异有统计学意义(P <0.05)。结论外侧DLM成形术能拯救更多有功能的残余物,对外侧DLM损伤患者的下肢力线改善作用更明显,在延缓膝关节软骨退变方面更有优势。

Objective To investigate the effect of lateral discoid meniscus(DLM) plasty on early osteoarthritis. Method 56 cases(60 knees) were enrolled and divided into treatment group and control group. Treatment group, clinical features of 30 patients with 32 knees of symptomatic DLM were summarized and arthroscopic meniscoplasty was performed;control group, DLM subtotal resection under arthroscopy was performed on 26 patients with 28 knees of symptomatic DLM;Three time-points were taken before treatment, from the beginning of treatment to week 20 and 2 year after treatment. VAS score, McMurray test, X-ray for(weight-bearing orthotopic) femorotibial angle(FTA), medial cartilage injury grade of knee MRI, and Harris score were observed in the two groups. Comparison between and within groups of two data rows at different time points. Result The score of Harris knee function in treatment group ranged from 41 ~ 89(61.87 ± 10.75) before surgery to 79 ~ 96(88.43 ± 3.99) when followed up 2 year later(P < 0.05). In control group, the Harris knee function score ranged from 50 ~ 86(61.67 ± 8.47) before surgery to 75 ~ 95(85.76 ± 4.74) at 2-year follow-up(P < 0.05). At the end of followup, the knee function of the treatment group was better than that of the control group, the difference had statistically significant(P < 0.05). Conclusion Lateral discoid meniscus plasty can save more functional remnants, improve the lower limb strength line of patients with lateral discoid meniscus injury more obviously, and have an advantage in delaying the degeneration of knee articular cartilage.