关节镜下治疗内侧半月板后角联合外侧半月板前角损伤疗效  

EFFECTIVENESS OF ARTHROSCOPIC TREATMENT FOR COMBINED INJURY OF POSTERIOR HORN OF MEDIAL MENISCUS AND ANTERIOR HORN OF LATERAL MENISCUS

作　　者：陈志伟[1] 伍俊星 梁先勇[1] 盛真[1] 

机构地区：[1]南华大学附属第一医院骨科,湖南衡阳421001

出　　处：《中国修复重建外科杂志》2014年第4期438-441,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨关节镜下治疗内侧半月板后角联合外侧半月板前角损伤的临床疗效。方法 回顾分析2009年9月-2012年12月收治的36例（36膝）内侧半月板后角联合外侧半月板前角损伤患者临床资料。男16例,女20例;年龄30～64岁,平均47岁。左膝14例,右膝22例。2例为扭伤,其余患者无明显诱因。病程3个月～9年,中位病程30个月。膝关节活动不同程度受限,内侧间隙后内侧压痛36例,外侧间隙前方压痛26例;麦氏征均为阳性。关节腔内积液5例。术前X线片及MRI检查,提示内侧半月板后角联合外侧半月板前角损伤30例;内侧半月板后角损伤6例,其外侧半月板未见明显异常;合并半月板囊肿2例,腘窝囊肿1例。于关节镜下内侧半月板后角损伤均采用半月板成形术,外侧半月板前角损伤采用半月板外-内缝合或成形术。结果 术后切口均Ⅰ期愈合,无相关并发症发生。36例均获随访,随访时间10～40个月,平均22.5个月。末次随访时,患者膝关节无疼痛、发软、不稳等症状,膝关节内、外侧间隙压痛消失;麦氏征除4例弱阳性外,余均为阴。采用改良Lysholm评分标准评定疗效,获优25例,良8例,可3例,优良率91.7%。结论 关节镜下一期修复内侧半月板后角联合外侧半月板前角损伤能有效恢复膝关节功能,疗效较好。Objective To investigate the effectiveness of arthroscopic treatment for combined injury of the posterior horn of the medial meniscus （PHMM） and the anterior horn of the lateral meniscus （AHLM）. Methods Between September 2009 and December 2012, 36 patients （36 knees） with combined injury of PHMM and AHLM underwent arthroscope surgery. There were 16 males and 20 females with an average age of 47 years （range, 30-64 years）, and a median disease duration of 30 months （range, 3 months-9 years）. The left knee was involved in 14 cases and the right knee in 22 cases. Two patients had a history of sprain, and other patients had no obvious incentive. The patients had limited activity of the knee in varying degrees; posterior medial tenderness in the medial knee joint space and positive Mcmurray tests were found in all cases, and anterior tenderness in the lateral knee joint space in 26 cases. Effusion of the knee joint occurred in 5 cases. The X-ray and MRI before operation indicated injury of PHMM combined with injury of AHLM in 30 cases and simple injury of PHMM in 6 cases; meniscal cyst was found in 2 cases, and popliteal cyst in 1 case. Partial meniscectomy was used for PHMM, the external-inner suture or partial meniscectomy was used for AHLM. Results All incisions healed primarily with no complication. All cases were followed up 22.5 months on average （range, 10-40 months）. At last follow-up, the patients had no pain, weakness, and instability, and tenderness in medial and lateral joint space disappeared. Except 4 patients who had weakly positive Mcmurray test, the results of Mcmurray test were negative in the others. Based on the improved Lysholm classification standard, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases; the excellent and good rate was 91.7%. Conclusion Arthroscopic primary repair of combined injury of PHMM and AHLM can effectively recover the knee function with a better effectiveness.

关 键 词：半月板损伤 内侧半月板 外侧半月板 关节镜 

分 类 号：R687.4[医药卫生—骨科学]