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针对青少年外侧半月板外周纵向撕裂不进行盘状化处理的盘状半月板修复术

Discoid lateral meniscal repair without saucerization for adolescents with peripheral longitudinal tear.

作者信息

Kinugasa Kazutaka, Hamada Masayuki, Yonetani Yasukazu, Matsuo Tomohiko, Mae Tatsuo, Nakata Ken, Horibe Shuji

机构信息

Department of Sports Orthopaedics, Osaka Rosai Hospital, Osaka, Japan.

Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Osaka, Japan.

出版信息

Knee. 2019 Jun;26(3):803-808. doi: 10.1016/j.knee.2019.03.007. Epub 2019 May 7.

Abstract

Recently, successful clinical outcomes for symptomatic discoid lateral meniscus (DLM) have been reported following partial meniscectomy (saucerization) with repair. In contrast, some studies using radiography and magnetic resonance imaging (MRI) have suggested that function of load transmission might not be appropriately maintained after saucerization with repair. Therefore, in pursuit to uphold load transmission after surgery for DLM, this study tried to preserve the DLM shape to keep the original DLM function. Discoid lateral meniscus repair without saucerization was indicated, with strict criteria, for those who had a painful peripheral longitudinal tear with purely intact body caused after a single traumatic incidence. The repair was performed without saucerization for four adolescents (two males, two females; mean age 16.2 years; three complete types of DLM, and one incomplete type of DLM). Postoperatively, the following were evaluated with radiography and MRI at six, 12, and 24 months after surgery: clinical outcomes, degenerative changes, and morphology of repaired DLM. They all showed good clinical outcomes. Furthermore, no degeneration, deformation, nor extrusion was observed at the two-year follow-up after surgery. For limited cases of DLM, as mentioned above, DLM repair without saucerization can be one treatment option.

摘要

最近,有报道称,在进行半月板部分切除术(碟形化)并修复后,有症状的盘状外侧半月板(DLM)取得了成功的临床治疗效果。相比之下,一些使用X射线摄影和磁共振成像(MRI)的研究表明,在进行碟形化修复后,负荷传递功能可能无法得到适当维持。因此,为了在DLM手术后维持负荷传递,本研究试图保留DLM的形状以保持其原始功能。对于因单次创伤事件后出现疼痛性周边纵向撕裂且本体完全完整的患者,严格按照标准进行无碟形化的盘状外侧半月板修复。对四名青少年(两名男性,两名女性;平均年龄16.2岁;三名完全型DLM和一名不完全型DLM)进行了无碟形化修复。术后,在术后6个月、12个月和24个月通过X射线摄影和MRI对以下方面进行评估:临床治疗效果、退变情况以及修复后DLM的形态。他们均显示出良好的临床治疗效果。此外,在术后两年的随访中未观察到退变、变形或挤出情况。对于上述有限的DLM病例,无碟形化的DLM修复可以作为一种治疗选择。

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