膝关节镜下中心成形联合边缘稳定术治疗外侧盘状半月板损伤  

Arthroscopic partial central meniscectomy with fixation of peripheral tear for unstable lateral discoid meniscus injury

作　　者：张洪鑫[1] 于洪昌 宋波[2] 杨晓明[1] 潘昭勋[1] 

机构地区：[1]解放军第89医院骨科研究所关节外科,山东潍坊261021 [2]潍坊职业学院信息工程学院

出　　处：《中国骨与关节损伤杂志》2015年第6期599-602,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨关节镜下中心成形联合边缘稳定术治疗外侧盘状半月板损伤的疗效。方法收集自2009-01—2013-08诊治的盘状半月板损伤68例（72膝）,经MRI和关节镜下确诊后,随机分成2组。A组给予保留边缘6～8 mm成形联合半月板稳定术,进行体部、肌腱裂口周围垂直缝合固定,前、后角经胫骨骨道固定;B组行盘状半月板全切或次全切除术。观察2组术后3、6、12膝关节功能Lysholm评分,术后12个月MRI半月板板台比。结果 A组34例获得随访,B组34例获得随访,随访时间平均12.3（12～14）个月。患者术后关节活动度恢复满意,关节交锁及弹响症状消失,无再撕裂或因症状复发需要二次手术者。2组术后3、6个月Lysholm评分差异无统计学意义（t=1.826,P=0.077;t=0.442,P=0.661）;术后12个月A组Lysholm评分较B组高,差异有统计学意义（t=3.718,P=0.001）。A组术后12个月MRI半月板板台比为（9.2±2.6）%,B组为（5.0±2.7）%,A组残存半月板板台比较B组高,差异有统计学意义（t=3.475,P=0.001）;但比同侧正常的（12.3%）低。结论对于不稳定盘状软骨损伤,在半月板成形的基础上,给予周边缝合固定及前后角重建固定,能最大程度地保留外侧半月板周缘并保持其稳定性,具有良好的短期疗效。Objective To investigate the efficacy of arthroscopic central meniscectomy and the marginal stability in the treatment of lateral discoid meniscus injury. Methods Sixty-eight cases（72 knees） of lateral discoid meniscus diagnosed by The MRI and endoscopy,were randomly divided into two groups（AB）,group A（34 cases,38 knees） for meniscus marginal stability group,vertical sutured line body,sutured rip of anterior / posterior horn through the tibial tunnel; group B（34 cases,34 knees） for total or subtotal discoid meniscus resection. Clinical evaluation index included Lysholm score,MRI evaluation12 months after operation,judging healing,tibial plateau coverage. Results The follow-up time ranged from 12 to 14 months,average 12.3 months. The postoperative Mc Murray＇s test was negative. There was significant difference between group A and B in the 12 th month follow-up（t =3.718,P =0.001）,but no significant difference in the 3rd and 6th month follow-up（t =1.826,P =0.077;t =0.442,P =0.661）. The Postoperative MRI showed that group A had better morphology（shins degree）,healing and better tibial plateau coverage than group B,with significant difference（t =3.475,P =0.001）. Conclusion The method for the treatment of unstable discoid meniscus injury has good short-term efficacy,based on meniscus plasty,the reconstruction of peripheral suture,anterior / posterior horn suture fixation.

关 键 词：盘状半月板损伤 半月板成形术 半月板缝合术 关节镜 

分 类 号：R684.7[医药卫生—骨科学]