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关节镜下半月板切除术治疗盘状外侧半月板撕裂:62例膝关节观察

Torn discoid lateral meniscus treated with arthroscopic meniscectomy: observations in 62 knees.

作者信息

Lu Ying, Li Qiang, Hao Jie

机构信息

Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

出版信息

Chin Med J (Engl). 2007 Feb 5;120(3):211-5.

Abstract

BACKGROUND

Discoid lateral meniscus of the knee is common in Chinese population. There has been considerable debate about the best treatment for discoid lateral meniscus tears. The purpose of this study was to observe the effect of arthroscopic meniscectomy for the treatment of discoid lateral meniscus tears.

METHODS

Between July 1999 and December 2004, arthroscopic meniscectomy was performed on 62 menisci of 57 patients with discoid lateral meniscus tears (52 unilateral, 5 bilateral). 41 menisci were "complete discoid meniscus", 21 "incomplete". According to the extent of the meniscus tears, partial meniscectomy was performed on 52 knees, total meniscectomy on 7 knees, and partial meniscectomy combined with meniscus suture on 3 knees through an arthroscope. After the operations, early rehabilitation training programs, including straight-leg-raising and range-of-motion exercises, were carried out. 51 patients were followed up for 1 year 2 months to 6 years 5 months (mean, 3 years 3 months), 6 patients were lost. Lysholm-II scoring system was used to assess the function of the knee joints before the operation and during the follow-up.

RESULTS

The operations on all the 62 knees were successful without complications. The patients could walk normally after completing the 2-week postoperation rehabilitation program. After 3 - 4 weeks they could lead a normal life and participate in a moderate amount of sports or other physical activities. The mean Lysholm-II score was 89 (60 - 100) during the follow-up, which was significantly higher than that before the operation (50, range 34 - 74; P < 0.01). 88% of the patients achieved excellent or good clinical results.

CONCLUSIONS

Arthroscopic meniscectomy is an alternative for treatment of discoid lateral meniscus tears with minimal traumatic effects. It can achieve early mobilization and a low complication rate, as well as the preservation of the meniscus structure and functions to the largest extent. In combination with proper rehabilitation training, the operation can lead to good or excellent results.

摘要

背景

盘状外侧半月板在中国人中较为常见。关于盘状外侧半月板撕裂的最佳治疗方法一直存在相当大的争议。本研究的目的是观察关节镜下半月板切除术治疗盘状外侧半月板撕裂的效果。

方法

1999年7月至2004年12月,对57例盘状外侧半月板撕裂患者(52例单侧,5例双侧)的62个半月板进行了关节镜下半月板切除术。41个半月板为“完全盘状半月板”,21个为“不完全盘状半月板”。根据半月板撕裂的程度,通过关节镜对52个膝关节进行了部分半月板切除术,7个膝关节进行了全半月板切除术,3个膝关节进行了部分半月板切除术联合半月板缝合术。术后进行了早期康复训练计划,包括直腿抬高和活动范围练习。51例患者随访1年2个月至6年5个月(平均3年3个月),6例失访。采用Lysholm-II评分系统评估术前及随访期间膝关节的功能。

结果

62个膝关节的手术均成功,无并发症。患者在完成术后2周康复计划后可正常行走。3 - 4周后,他们可以正常生活并参加适量的运动或其他体育活动。随访期间Lysholm-II评分平均为89分(60 - 100分),显著高于术前(50分,范围34 - 74分;P < 0.01)。88%的患者获得了优良的临床效果。

结论

关节镜下半月板切除术是治疗盘状外侧半月板撕裂的一种选择,创伤极小。它可以实现早期活动,并发症发生率低,并能在最大程度上保留半月板的结构和功能。结合适当的康复训练,该手术可取得良好或优异的效果。

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