关节镜修补中老年退变性内侧半月板损伤的疗效观察及影像学评估

Efficacy observation and imaging evaluation of arthroscopic repair of degenerative medial meniscus injury in middle-aged and elderly patients

目的观察关节镜下修补45岁以上孤立的退变性内侧半月板损伤患者的临床效果并MRI评估随访2年以上的愈合情况。方法回顾性研究2016年1月至2020年12月关节镜修补的51例孤立的退变性内侧半月板损伤患者的临床资料。手术采用全内缝合或者全内结合由内向外技术缝合半月板。记录手术前和末次随访(至少24个月)的IKDC评分、Tegner评分及Lysholm评分。记录术中半月板损伤类型及部位,软骨损伤的镜下分级及部位。同时MRI观察随访半月板的愈合情况、ICRS软骨损伤分级情况,MRI上0~2度损伤定为半月板愈合,3度损伤定为不愈合。临床修补失败根据Barrett评价标准判断。结果患者平均年龄(57.3±8.4)岁,平均随访(55.0±15.3)个月。47.1%为复杂裂,31.3%为水平裂,21.6%为其他类型。Lysholm评分由术前的(53.5±6.4)分升至术后的(87.6±7.9)分,IKDC评分由术前的(33.6±4.7)分升至术后的(72.8±5.3)分,Tegner评分由术前的(1.0±0.1)分升至术后的(4.0±0.5)分。3例患者判断为临床修补失败,5例患者术后软骨损伤有进展。至末次随访,在MRI上观察半月板愈合情况:0度2例(3.9%),1度17例(33.3%),2度11例(21.6%),3度21例(41.2%)。结论对于存在孤立的退变性内侧半月板损伤的中老年患者,若保守治疗效果不佳或者存在机械性阻挡因素,采用关节镜下修补半月板能够取得良好的临床效果且临床修补失败率较低。

Objective To observe the clinical effect of arthroscopic repair of isolated degenerative medial meniscus injury in patients over 45 years old and to evaluate the healing after more than two years of follow-up through MRI.Methods A retrospective study was conducted on the clinical effects of 51 patients with isolated degenerative medial meniscus injury who underwent arthroscopic repair from January 2016 to December 2020.The meniscus was sutured by total internal suture or total internal suture combined with internal-toexternal technique.IKDC score,Tegner score and Lysholm score were recorded before operation and at the last follow-up(at least 24 months).The type and location of meniscus injury during operation,and the microscopic classification and location of cartilage injury were recorded.At the same time,MRI was used to observe the healing of meniscus and ICRS cartilage injury grading.On MRI,0-2 degree injury was defined as meniscus healing,and 3 degree injury was defined as nonunion.The clinical repair failure was judged according to the Barrett evaluation criteria.Results The average age of the patients was(57.3±8.4)years,and the average follow-up time was(55.0±15.3)months.There were 47.1%complex fissures,31.3%horizontal fissures and 21.6%other types.The Lysholm score increased from 53.5±6.4 preoperative to 87.6±7.9 postoperative,the IKDC score increased from 33.6±4.7 preoperative to 72.8±5.3 postoperative,and the Tegner score increased from 1.0±0.1 preoperative to 4.0±0.5 postoperative.Three patients were judged as clinical repair failure,and five patients had progressed cartilage injury after surgery.At the last follow-up,the meniscus healing was observed on MRI:0 degree in two cases(3.9%),1 degree in 17 cases(33.3%),2 degree in 11 cases(21.6%),3 degree in 21 cases(41.2%).Conclusion For middle-aged and elderly patients with isolated de-generative medial meniscus injury,if conservative treatment is not effective or there are mechanical obstruc-tion factors,arthroscopic meniscus repair can achieve good clinical results and low clinical repair failure rate.