老年膝关节半月板损伤关节镜手术方式选择及疗效评估

Selection of arthroscopic surgical methods for meniscus tear in the elderly and evaluation of curative effect

目的:探讨关节镜治疗老年半月板损伤的方法和疗效。方法:自2014年1月至2018年6月,86例符合纳入标准的老年半月板损伤患者,其中男35例,女51例;年龄60~76岁,平均63.7岁;有明确外伤史32例,无明确外伤史54例。关节镜下半月板部分切除75例,部分切除及前角修补2例,部分切除及体部修补2例,后角水平分层破裂部分切除及修补7例;28例合并关节轻度退变,同时行髁间窝钻孔减压。术前及末次随访采用Lysholm评分和IKDC评分评定膝关节功能,视觉模拟评分法(VAS)评估疼痛情况。结果:所有病例成功完成关节镜下手术,随访6~36个月,平均15个月。膝关节Lysholm评分由术前(51.26±12.00)分,提高至末次随访的(81.20±4.89)分(t=22.07,P<0.001);IKDC评分由术前(48.05±10.68)分,提高至末次随访的(76.97±6.26)分(t=23.04,P<0.001);VAS由术前(3.37±0.84)分,改善至末次随访的(0.57±0.62)分(t=36.27,P<0.001)。2例非外伤性退变性内侧半月板损伤伴内侧骨关节炎患者,术后1年症状无明显改善,行人工全膝关节置换术。结论:老年膝关节半月板损伤行关节镜下半月板部分切除,或部分切除及修补术治疗,可获得较满意的临床效果;如果合并关节轻度退变性变,同时行髁间窝钻孔减压。

Objective:To evaluate the methods and effects of arthroscopic operation in aged patients with meniscal injury.Methods:From January 2014 to June 2018,86 elderly patients with meniscal injury met the inclusion criteria,including 35 males and 51 females,aged 60 to 76 years old,with an average age of 63.7 years old,32 patients with definite trauma and 54 without definite trauma.Arthroscopic partial meniscectomy was performed in 75 cases,partial meniscectomy and anterior angle repair in 2 cases,partial meniscectomy and body repair in 2 cases,and partial meniscectomy and repair in 7 cases of horizontal delamination rupture of posterior horn;28 patients with mild joint degeneration went through drilling decompression of intercondylar fossa.Lysholm score and IKDC score were used to evaluate knee joint function and visual analogue scale(VAS)was used to evaluate pain.Results:All patients were successfully operated under arthroscope.The follow-up period ranged from 6 to 36 months,with an average of 15 months.The Lysholm score of knee joint increased from preoperative 51.26±12.00 to final follow-up 81.20±4.89 points(t=22.07,P<0.001);IKDC scores increased from preoperative 48.05±10.68 to final follow-up 76.97±6.26(t=23.04,P<0.001);and the VAS decreased from preoperative 3.37±0.84 to final follow-up 0.57±0.62(t=36.27,P<0.001).Two patients with non-traumatic degenerative medial meniscus injury with medial osteoarthritis had no significant improvement after 1 year follow-up,so underwent total knee arthroplasty.Conclusion:In elderly patients with knee meniscus injury,arthroscopic partial meniscectomy,or partial meniscectomy and repair can achieve satisfying clinical results.If the injuried joint is accompanied with mild degeneration,drilling hole decompression of intercondylar fossa should be performed at the same time.