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半月形和盘状外侧半月板损伤患者关节镜下部分半月板切除术前与术后的生物力学差异。

Biomechanical differences before and after arthroscopic partial meniscectomy in patients with semilunar and discoid lateral meniscus injury.

作者信息

Li Yaqiang, Wu Yu, Zeng Yiming, Gu Dongyun

机构信息

Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai 200011, China.

Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of People's Republic of China Shanghai 200030, China.

出版信息

Am J Transl Res. 2020 Jun 15;12(6):2793-2804. eCollection 2020.

Abstract

The purpose of the current study was to investigate the differences in knee kinematics and kinetics in patients with semilunar lateral meniscus (SLM) and discoid lateral meniscus (DLM) injuries before and after arthroscopic partial meniscectomy during level walking. Fifteen healthy volunteers (control group), thirteen patients with SLM injury (SLM group) and nine patients with DLM injury (DLM group) were enrolled in our study. Gait analyses were performed pre- and post-operatively during level walking at a self-selected walking speed. Our results showed that compared to the control group before surgery, the SLM and DLM groups showed significantly lower walking speed, shorter stride length, lower maximum knee flexion during stance phase and swing phase, lower first peak knee flexion moment, and smaller adduction-abduction range of motion (ROM) during the gait cycle. Compared to the control group, only the DLM group showed significantly decreased flexion-extension ROM and maximum abduction angle. The first peak knee adduction moment was lower in the SLM group than in the control group. Significant difference was observed in first peak knee flexion moment between SLM and DLM groups. After surgery, there were no significant differences in gait spatiotemporal parameters, knee kinematics, and kinetics between the three groups, indicating that meniscectomy is an effective treatment for both types of injury. By using three-dimensional gait analysis, the current results revealed that lateral meniscus types influence gait patterns after injury, which may further impact clinical treatment choice and long-term prognosis.

摘要

本研究的目的是调查外侧半月板(SLM)损伤和盘状外侧半月板(DLM)损伤患者在关节镜下部分半月板切除术前和术后平路行走时膝关节运动学和动力学的差异。15名健康志愿者(对照组)、13名SLM损伤患者(SLM组)和9名DLM损伤患者纳入本研究。在术前和术后以自选步行速度进行平路行走时进行步态分析。我们的结果显示,与术前对照组相比,SLM组和DLM组的步行速度显著降低,步幅缩短,站立期和摆动期的最大膝关节屈曲度降低,首次峰值膝关节屈曲力矩降低,步态周期内的内收-外展活动范围(ROM)减小。与对照组相比,只有DLM组的屈伸ROM和最大外展角度显著降低。SLM组的首次峰值膝关节内收力矩低于对照组。SLM组和DLM组之间的首次峰值膝关节屈曲力矩存在显著差异。术后,三组之间的步态时空参数、膝关节运动学和动力学均无显著差异,表明半月板切除术对两种类型的损伤都是一种有效的治疗方法。通过三维步态分析,目前的结果显示外侧半月板类型会影响损伤后的步态模式,这可能会进一步影响临床治疗选择和长期预后。

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