关节镜下外侧盘状半月板切除范围对单侧盘状半月板损伤患者下肢力线及膝关节功能的影响

Effect of excisional extent of lateral discoid meniscus in arthroscopic meniscectomy on lower limb alignment and knee joint function in patients with unilateral discoid meniscus injury

目的 探讨关节镜下外侧盘状半月板切除术中外侧盘状半月板切除范围对单侧盘状半月板损伤患者下肢力线及膝关节功能的影响。方法 选择2016年2月至2017年2月无锡市第三人民医院收治的85例单侧盘状半月板损伤患者为研究对象,患者均接受关节镜下外侧盘状半月板切除术治疗,根据外侧盘状半月板切除范围分为A组(40例)和B组(45例),A组患者术中外侧盘状半月板切除范围≥1/2,B组患者外侧盘状半月板切除范围<1/2。所有患者术后随访2a,分别于术前、术后1个月及术后1、2a测量患者下肢力线(固有偏距),并进行膝关节功能Lysholm评分和国际膝关节文献委员会(IKDC)评分。结果 2组患者术前下肢力线(固有偏距)比较差异无统计学意义(P>0.05);2组患者术后1个月及术后1、2a下肢力线(固有偏距)均小于术前(P<0.05),2组患者术后1、2a下肢力线(固有偏距)均小于术后1个月(P<0.05),2组患者术后2a下肢力线(固有偏距)均小于术后1a(P<0.05);术后1个月及术后1、2a,B组患者下肢力线(固有偏距)均小于A组(P<0.05)。2组患者术前膝关节功能Lysholm评分、IKDC评分比较差异均无统计学意义(P>0.05);2组患者术后1个月及术后1、2a膝关节功能Lysholm评分、IKDC评分均高于术前(P<0.05),2组患者术后1、2a膝关节功能Lysholm评分、IKDC评分均高于术后1个月(P<0.05);2组患者术后2a膝关节功能Lysholm评分、IKDC评分均高于术后1a(P<0.05);术后1个月及术后1、2a,B组患者膝关节功能Lysholm评分、IKDC评分均高于A组(P<0.05)。结论 关节镜下外侧盘状半月板切除术中应尽量减少半月板切除范围,最大限度地保留正常半月板,以利于术后下肢力线和膝关节功能的恢复。

Objective To investigate the effect of excisional extent of lateral discoid meniscus in arthroscopic meniscectomy on lower limb alignment and knee joint function in patients with unilateral discoid meniscus injury.Methods A total of 85 patients with unilateral discoid meniscus injury admitted to the Third People′s Hospital of Wuxi City from February 2016 to February 2017 were selected as the subjects,all patients underwent arthroscopic meniscectomy.The patients were divided into group A (n=40) and group B (n=45) according to the excisional extent of discoid lateral meniscus,the excisional extent of discoid lateral meniscus in group A was more than 1/2,while that in group B was less than 1/2.All patients were followed up for 2 years.The lower limb alignment (inherent deviation) was measured before operation,1 month and 1,2 years after operation;and the Lysholm score and the International Knee Documentation Committee (IKDC) score of knee joint function were performed.Results There was no significant difference in the lower limb alignment (inherent deviation) between the two groups before operation (P>0.05).The lower limb alignment (inherent deviation) at 1 month and 1,2 years after operation was less than that before operation in the two groups (P<0.05).The lower limb alignment (inherent deviation) at 1,2 years after operation was less than that at 1 month after operation in the two groups (P<0.05).The lower limb alignment (inherent deviation) at 2 years after operation was less than that at 1 year after operation in the two groups (P<0.05).The lower limb alignment (inherent deviation) in group B was less than that in group A at 1 month and 1,2 years after operation (P<0.05).There was no significant difference in Lysholm score and IKDC score of knee joint function between the two groups before operation (P>0.05).The Lysholm score and IKDC score of knee joint function at 1 month and 1,2 years after operation were higher than those before operation in the two groups (P<0.05).The Lysholm score and IKDC score of knee joint function at 1 and 2 years after operation were higher than those at 1 month after operation in the two groups (P<0.05).The Lysholm score and IKDC score of knee joint function at 2 years after operation were higher than those at 1 year after operation in the two groups (P<0.05).The Lysholm score and IKDC score of knee joint function in group B were higher than those in group A at 1 month and 1,2 years after operation (P<0.05).Conclusion In arthroscopic meniscectomy,the excisional extent of lateral discoid meniscus should be minimized and the normal meniscus should be preserved to the maximum extent,so as to facilitate the recovery of lower limb alignment and knee joint function after operation.