[关节镜治疗外侧盘状半月板损伤的疗效]

Hu Kejia, Feng Dehong, Wang Ling, Sun Zhenzhong, Rui Yongjun

Department of Orthopedics, Wuxi No.9 People's Hospital Affiliated to Soochow University & Wuxi Hand Surgery Hospital, Wuxi Jiangsu, 214062, P.R.China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Dec;26(12):1457-61.

OBJECTIVE

To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury.

METHODS

Between January 2010 and May 2011, 38 patients (42 knees) with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males (24 knees) and 15 females (18 knees), aged 7-62 years (median, 32.8 years). The disease duration was 7 days to 40 years (median, 8.6 months). According to Watanabe's classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients (28 knees), partial meniscectomy in 12 patients (13 knees), and complete meniscectomy in 1 patient (1 knee). After operation, the rehabilitation training programs (including straight-leg-raising exercise and range of motion exercise) were carried out.

RESULTS

All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months (mean, 14.3 months). No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation (P < 0.05). Based on Ikeuchi's grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 +/- 2.95 at immediate, 91.02 +/- 4.17 at 3 months, 92.90 +/- 3.36 at 6 months, and 94.74 +/- 3.52 at 12 months after operation from 69.38 +/- 4.59 before operation (P < 0.05).

CONCLUSION

Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.

目的

评估关节镜治疗外侧盘状半月板损伤的手术技术及疗效。

方法

2010年1月至2011年5月，38例（42膝）外侧盘状半月板损伤患者接受关节镜治疗。其中男性23例（24膝），女性15例（18膝），年龄7 - 62岁（中位数32.8岁）。病程7天至40年（中位数8.6个月）。根据渡边对盘状半月板的分类，完全型22膝，不完全型19膝，Wrisberg型1膝。25例（28膝）行半月板成形术联合缝合，12例（13膝）行部分半月板切除术，1例（1膝）行完全半月板切除术。术后进行康复训练计划（包括直腿抬高练习和活动度练习）。

结果

所有切口均一期愈合。患者在3 - 4周后基本恢复正常活动。所有患者均随访12 - 18个月（平均14.3个月）。无关节绞锁或弹响症状发生；随访期间未发现撕裂或翻修情况。术后3个月、6个月和1年时，屈伸活动度与术前相比均显著改善（P < 0.05）。根据池内分级，优22膝，良16膝，可4膝，优良率为90.4%。Lysholm评分术前为69.38 ± 4.59，术后即刻升至88.57 ± 2.95，3个月时为91.02 ± 4.17，6个月时为92.90 ± 3.36，12个月时为94.74 ± 3.52（P < 0.05）。