关节镜下手术治疗少儿膝关节半月板损伤  

Arthroscopic surgery in treatment of children meniscal tears

作　　者：王予彬[1] 王惠芳[1] 李国风[2] 李国平[2] 

机构地区：[1]同济大学附属东方医院运动创伤,关节外科,上海200120 [2]国家体育总局运动医学研究所,北京100061

出　　处：《中国医学工程》2007年第12期967-969,共3页China Medical Engineering

摘　　要：目的探讨少儿膝关节半月板损伤的膝关节镜下微创手术治疗的特点及其临床效果。方法本组患者29例,8岁～16岁,平均11岁。临床症状:患膝疼痛27例,弹响17例,交锁史13例,膝关节活动受限7例,跛行6例,膝部肿胀3例。膝关节间隙压痛28例,麦氏征阳性27例,MRI检查,21例为阳性结果。所有患儿都采用关节镜下手术。术中见半月板边缘撕裂11例,桶柄样撕裂13例,其中撕裂缘嵌顿于髁间窝部5例,前角损伤3例,后角损伤2例。关节镜下半月板损伤部分切除术3例,半月板缝合术26例。半月板缝合术后配戴支具,由专科治疗师行康复治疗。结果本组患者随访15～182个月,平均38个月,所有患儿术后关节功能恢复正常。1例剧烈活动后时有膝部肿胀,无跛行。Lysolme评分:术前(62±9),术后(94±6),P<0.01;膝关节功能评分,术前(59±6),术后(93±5),P<0.01。结论半月板损伤是少儿膝关节痛的原因之一,应引起临床医师的重视。少儿半月板损伤后多表现为交锁和关节活动受限。镜下特征:滑膜炎表现明显;多为纵形或桶柄样撕裂。少儿半月板,对膝关节正常功能影响很大。应尽可能采用半月板缝合术治疗。少儿关节镜下半月板缝合术后应配戴支具,由专业治疗师进行规范的康复训练。[ Objective] To investigate the clinical characteristic and principle results in mini-invasive surgery of children meniscal tears. [Method] 29 patients, 11 years older on average （8-16 y） were involved in the study. 27 patients complained about joint pain, 17 with audible click, 13 with giving way, blocking of ROM in 7, limp in 6, swelling in 3, joint llne tenderness in 28, a positive McMuray test in 27, and a positive MRI imaging in 21. All patients had mini-invasive surgery. Peripheral tears were found in 11 patients, ＂bucket handle＂ tears in 13 （torn meniscus blocked in femoral condoyle in 5）, anterior horn tears in 3, and posterior horn tears in 2. Arthroscopic partial meniseeetomy was performed on 3 patients, arthroseopic meniseal repair in 26. After the surgery, the knee was immobilized with a brace and postoperative rehabilitation was performed. [Result] The patients were Followed- up time for 38 months （ranged 8～182 months）. Normal ROM of knee in all patients was achieved. One patient had episode knee pain accompanied by vigorous activities. Lysolme grade was （62±9） preoperatively, and （94±6） postop-eratively （P〈0.01）. Knee functional scale was （59±6） preoperatively, and （93±5） postoperatively （P 〈0.001）. [Conclusion] As meniscal tear is one of the main problems of knee pain in children, it should be addressed in clinical treatment. Main complains of meniscal tears in children are limitation of ROM in knee and blocked knee. Synovitis is prominence under arthroscopy. Longitudinal tears and ＂bucket handle＂ tears are commonly seen in children. Arthroscopic meniscal repair shoulder is adopted as the importance of meniscus in knee function in juvenile. Standard rehabilitation protocol would be performed by a therapist.

关 键 词：半月板损伤 少儿 手术 关节镜 

分 类 号：R684[医药卫生—骨科学]