内侧半月板退变性损伤的关节镜下分型  

The arthroscopic classification of degenerative medial meniscus injury

作　　者：李儒军[1] 钟群杰[1] 倪磊[1] 林剑浩[1] 

机构地区：[1]北京大学人民医院骨关节科,100044

出　　处：《中华骨科杂志》2014年第3期293-297,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨内侧半月板退变性损伤的关节镜下分型及其临床意义。方法2012年1至12月因内侧半月板退变性损伤接受关节镜手术者122例，不包括因重度滑膜炎需做滑膜切除者。男27例，女95例；年龄37±80岁，平均（61．8±8．9）岁。左膝63例，右膝59例。BMI平均（26．5±3．4）k咖。，术前Lysholm评分（47．2±15．0）分。关节镜术中依据Out—erbfidge软骨损伤分级对软骨损伤进行评估，比较不同分型者（后角水平撕裂、后角根部损伤和复杂严重损伤）Ⅳ度软骨退变性损伤所累及的关节面数量及术前Lysholm评分。结果后角水平撕裂33例，Ⅳ度软骨退变性损伤累及的关节面（1．24±1．48）个，术前Lysholm评分（52．5±14.4）分，其中疼痛评分（7．7±6．5）分；后角根部损伤16例，Ⅳ度软骨退变性损伤累及的关节面（1．13±1．26）个，术前Lysholm评分（37．5±8．4）分，其中疼痛评分（3．1±4．0）分；复杂严重损伤73例，Ⅳ度软骨退变性损伤累及的关节面平均（2．26±1．61）个，术前Lysholm评分平均（46．9±15-3）分，其中疼痛评分（6．8±5．4）分。后角根部损伤者术前Lysholm评分低于后角水平撕裂和复杂严重损伤者，差异有统计学意义；其中疼痛评分的差异也有统计学意义。后角根部损伤者Ⅳ度软骨退变性损伤累及的关节面数量与后角水平撕裂者的差异无统计学意义；均小于复杂严重损伤者，差异有统计学意义。结论关节镜下内侧半月板退变性损伤可分为三种类型。后角根部损伤和后角水平撕裂的软骨退变性损伤相对较轻，是较早期的关节退变；其中后角根部损伤的II缶床症状和功能减退较为明显。复杂严重损伤的软骨退变性损伤相对较重，是较晚期的关节退变，但临床症状和功能减退却相对较轻。Objective To explore the classification of degenerative medial meniscus injury under arthroscopy and its clinical significance. Methods This study involved 122 patients who underwent arthroscopic operation because of degenerative medial meniscus injury from January 2012 to December 2012, eliminating patients who received synovectomy for severe synovitis. There were 27 males and 95 females, with 63 left knees and 59 right knees. The average age was 61.8±8.9 years. The average BMI was 26.5±3.4 kg/mz, while the average preoperative Lysholm score was 47.2± 15.0. The cartilage injury was estimated by Outer- bridge classification system during arthroscopic surgery. Both the difference of the preoperative Lysholm score and the number of articular surfaces with IV degree of cartilage injury were compared among different types of degenerative medial meniscus injury. Results The horizon tear of posterior horn group included 33 patients. The average number of articular surfaces with IV degree of cartilage injury was 1.24± 1.48 while the average preoperative Lysholm score was 52.5± 14.4 points, with pain score of 7.7±6.5. The root injury of posterior horn group included 16 patients, whose average number of articular surfaces with Ⅳ degree of cartilage injury was 1.13-± 1.26 and average preoperative Lysholm score was 37.5±8.4 points, with pain score of 3.1±4.0. The complex seri- ous injury group included 73 patients. The average number of articular surfaces with IV degree of cartilage injury was 2.26-± 1.61 and the average preoperative Lysholm score was 46.9-±15.3 points, with pain score of 6.8-±5.4. Both the preoperative Lysholm score and pain score of the root injury of posterior horn group was significantly lower than that of the horizon tear and the complex seri- ous injury group. The average number of articular surfaces with IV degree of cartilage injury between the root injury and the hori- zon tear of posterior horn group had no significant difference. The number of these two groups was less than the comp

关 键 词：半月板 胫骨 膝关节 关节镜检查 

分 类 号：R687.4[医药卫生—骨科学]