Shi Wen-Ji, Mao Bin-Yao
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China;
Department of Orthopaedics, Ningbo First Hospital, Ningbo 315010, Zhejiang, China.
Zhongguo Gu Shang. 2019 Dec 25;32(12):1085-1089. doi: 10.3969/j.issn.1003-0034.2019.12.003.
To evaluate the methods and effects of arthroscopic operation in aged patients with meniscal injury.
From January 2014 to June 2018, 86 elderly patients with meniscal injury met the inclusion criteria, including 35 males and 51 females, aged 60 to 76 years old, with an average age of 63.7 years old, 32 patients with definite trauma and 54 without definite trauma. Arthroscopic partial meniscectomy was performed in 75 cases, partial meniscectomy and anterior angle repair in 2 cases, partial meniscectomy and body repair in 2 cases, and partial meniscectomy and repair in 7 cases of horizontal delamination rupture of posterior horn; 28 patients with mild joint degeneration went through drilling decompression of intercond-ylar fossa. Lysholm score and IKDC score were used to evaluate knee joint function and visual analogue scale(VAS) was used to evaluate pain.
All patients were successfully operated under arthroscope. The follow-up period ranged from 6 to 36 months, with an average of 15 months. The Lysholm score of knee joint increased from preoperative 51.26±12.00 to final follow-up 81.20±4.89 points (=22.07, <0.001); IKDC scores increased from preoperative 48.05±10.68 to final follow-up 76.97±6.26(=23.04, <0.001); and the VAS decreased from preoperative 3.37±0.84 to final follow-up 0.57±0.62(=36.27, <0.001). Two patients with non-traumatic degenerative medial meniscus injury with medial osteoarthritis had no significant improvement after 1 year follow-up, so underwent total knee arthroplasty.
In elderly patients with knee meniscus injury, arthroscopic partial meniscectomy, or partial meniscectomy and repair can achieve satisfying clinical results. If the injuried joint is accompanied with mild degeneration, drilling hole decompression of intercondylar fossa should be performed at the same time.
评估关节镜手术治疗老年半月板损伤患者的方法及效果。
选取2014年1月至2018年6月符合纳入标准的86例老年半月板损伤患者，其中男性35例，女性51例，年龄60～76岁，平均年龄63.7岁；有明确外伤史者32例，无明确外伤史者54例。75例行关节镜下半月板部分切除术，2例行半月板部分切除加前角修补术，2例行半月板部分切除加体部修补术，7例后角水平分层破裂行半月板部分切除加修补术；28例轻度关节退变患者行髁间窝钻孔减压术。采用Lysholm评分和IKDC评分评估膝关节功能，采用视觉模拟评分法（VAS）评估疼痛程度。
所有患者均在关节镜下顺利完成手术。随访时间6～36个月，平均15个月。膝关节Lysholm评分由术前的51.26±12.00分提高至末次随访时的81.20±4.89分（=22.07，<0.001）；IKDC评分由术前的48.05±10.68分提高至末次随访时的76.97±6.26分（=23.04，<0.001）；VAS评分由术前的3.37±0.84分降至末次随访时的0.57±0.62分（=36.27，<0.001）。2例非创伤性退变内侧半月板损伤合并内侧骨关节炎患者随访1年效果不佳，行全膝关节置换术。
对于老年膝关节半月板损伤患者，关节镜下半月板部分切除术或半月板部分切除加修补术可取得满意的临床效果。若损伤关节伴有轻度退变，可同时行髁间窝钻孔减压术。
