儿童膝关节病及其关节镜诊治

Arthroscopic examination and treatment of knee arthrosis in children

目的 探讨儿童膝关节病临床特点及其关节镜诊断和治疗。方法 1990～ 2 0 0 1年使用 4mm、30°关节镜对 112例年龄 3.5～ 14岁 (平均 9.8± 2 .9)的患儿进行膝关节疾病诊治。男 5 5例、女 5 7例。 5 4例 (6 3膝 )外侧盘状半月板损伤行部分切除成形术 ;17例半月板损伤行部分切除术 ;6例色素沉着绒毛结节性滑膜炎、2例滑膜结核、2例化脓性关节炎和 2例反应性关节炎行滑膜切除术 ;8例髌内侧滑膜皱襞综合征和 3例脂肪垫挤夹综合征行部分切除术 ;6例剥脱性骨软骨炎和 3例骨软骨损伤行关节面清理术和游离体取出术 ;3例髌骨半脱位和 2例开放式滑膜切除术后关节粘连行松解术 ;4例胫骨髁间嵴撕脱骨折行内固定术。结果 本组盘状半月板损伤、半月板损伤和滑膜炎分别占 4 8%、15 %和11%。术后无并发症。 92例随访 0 .5～ 12年 (平均 3.7± 2 .8)。满意 84例 (91.3% ) ;不满意 4例 ;差 4例 ,行再次关节镜手术。结论 外侧盘状半月板损伤是儿童最常见的膝关节疾病。多数儿童膝关节疾病与外伤有关 ,关节镜诊治儿童膝关节病是一种微创手术 。

Objective To investigate the clinical features and arthroscopic procedures for the diagnosis and treatment of childhood knee joint pathological conditions. Methods From 1990 to 2001, one hundred and twelve children (121 knees) including 55 boys and 57 girls with a mean age of 9.8± 2.9 years (range: 3.5～14 yrs) had knee arthroscopy with a 4.0 mm diameter, 30° arthroscope. The arthroscopic procedures included partial meniscectomy for torn lateral discoid meniscus in 54 patients (63 knees), partial meniscectomy for torn meniscus in 17, synovectomy of pigmented villionodullar synovitis in 6, tuberculous synovitis in 2, pyarthrosis in 2 and reactionary arthritis in 2, partial resection of mediopatella plica in 3, Hoffa's disease in 2, cartilage debridement and loose-body removal of osteochondritis dissecans in 6, osteochondral fractures in 3, release of patellar subluxation in 3, adhesions after an open synovectomy in 2, and internal fixation of tibial eminence fracture in 4. Results The main diseases of knee joint treated were torn lateral discoid meniscus (49%), torn meniscus (15%) and synovitis (11%). There was no complication after arthroscopy. 92 patients were followed up with mean duration of 3.7± 2.8 years (range 0.5～12 yrs). Satisfactory results were obtained in 84 patients. 4 patients had unsatisfactory results and another 4 patients had bad results and needed repeated arthroscopies. Conclusions Lateral discoid meniscus tear is the main pathology of the knee joint in children of this series. Diseases related to injury are most common. Arthroscopy is a minimally invasive procedure with satisfactory results for knee pathologies in children.