[关节镜与保守治疗对中老年有症状盘状外侧半月板的中期疗效]
[Mid-term effectiveness of arthroscopy and conservative treatment for symptomatic discoid lateral meniscus in middle-aged and elderly patients].
作者信息
Yang Shunjie, Wang Lingcheng, You Mingke, Yang Shuoyao, Xue Yang, Chen Gang
机构信息
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jan 15;37(1):6-11. doi: 10.7507/1002-1892.202208064.
OBJECTIVE
To compare the mid-term effectiveness of arthroscopy versus conservative treatment on symptomatic discoid lateral meniscus (SDLM) in middle-aged and elderly patients.
METHODS
The clinical data of 118 middle-aged and elderly patients (154 knees) with SDLM who received arthroscopy or conservative treatment between June 2014 and May 2016 were retrospectively analyzed, including 76 patients (96 knees) in the arthroscopy group (group A) and 42 patients (58 knees) in the conservative treatment group (group B). There was no significant difference in age, gender, and body mass index between the two groups (>0.05). Compared with group B, the symptoms duration in group A was longer, the incidences of discoid lateral meniscus injury and mechanical symptoms were higher, and the visual analogue scale (VAS) score and Lysholm score before treatment were worse, with significant differences (<0.05). VAS score and Lysholm score before and after treatment were recorded and compared.
RESULTS
The patients in both groups were followed up 60-74 months, with an average of 66.3 months. The follow-up time of group A and group B was (65.9±3.5) months and (67.0±4.0) months respectively, with no significant difference (=-1.615, =0.109). At last follow-up, in either group A or group B, the VAS score and Lysholm score significantly improved when compared with those before treatment (<0.05). The differences of VAS score and Lysholm score in group A before and after treatment were significantly better than those in group B (<0.05).
CONCLUSION
Arthroscopy and conservative treatment have a satisfactory mid-term effectiveness on SDLM in middle-aged and elderly patients. However, the improvement of symptoms and function of arthroscopy was significantly better than that of conservative treatment. For middle-aged and elderly SDLM patients with invalidated conventional treatment for 6 months, severe clinical symptoms, long duration of symptoms, and combined with mechanical symptoms, arthroscopy should be given priority even if they are complicated with early osteoarthritis.
目的
比较关节镜手术与保守治疗对中老年有症状盘状外侧半月板（SDLM）的中期疗效。
方法
回顾性分析2014年6月至2016年5月期间接受关节镜手术或保守治疗的118例中老年SDLM患者（154膝）的临床资料，其中关节镜手术组（A组）76例（96膝），保守治疗组（B组）42例（58膝）。两组患者年龄、性别、体重指数比较，差异无统计学意义（>0.05）。与B组比较，A组症状持续时间更长，盘状外侧半月板损伤及机械性症状发生率更高，治疗前视觉模拟评分（VAS）及Lysholm评分更差，差异有统计学意义（<0.05）。记录并比较两组治疗前后VAS评分及Lysholm评分。
结果
两组患者均随访60 - 74个月，平均66.3个月。A组和B组随访时间分别为（65.9±3.5）个月和（67.0±4.0）个月，差异无统计学意义（=-1.615，=0.109）。末次随访时，A组和B组VAS评分及Lysholm评分均较治疗前显著改善（<0.05）。A组治疗前后VAS评分及Lysholm评分改善程度均显著优于B组（<0.05）。
结论
关节镜手术与保守治疗对中老年SDLM患者均有满意的中期疗效。然而，关节镜手术在症状及功能改善方面显著优于保守治疗。对于经6个月常规治疗无效、临床症状严重、症状持续时间长且合并机械性症状的中老年SDLM患者，即使合并早期骨关节炎，也应优先选择关节镜手术。
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