影响关节镜下半月板部分切除术后第1年疗效的相关因素分析  

Factors related to one-year efficacy of arthroscopic partial meniscectomy

作　　者：李小亚[1] 周小小[1] 朱贤平[1] 滕晓[1] 

机构地区：[1]台州市中心医院骨科,318000

出　　处：《浙江医学》2016年第9期639-642,666,共5页Zhejiang Medical Journal

摘　　要：目的明确影响关节镜下半月板部分切除术(APM)后第1年膝关节功能的相关因素。方法对行APM且完成术后1年随访的82例患者使用术后1年随访时的术后疼痛明显缓解(SPR)时间、Lysholm评分及Tegner评分作为标准来评价所有变量对膝关节功能的影响。对患者的术前变量及术中关节镜检查结果与APM后的临床预后进行多变量回归分析。结果患者的手术满意率为79.0%(65例),术后SPR时间平均为(3.3±1.8)个月。术中关节镜检查发现内侧半月板撕裂、退变性半月板撕裂及Ⅱ度软.骨损伤的患者所占比例最多。术后Lysholm评分明显高于术前(P<0.01),术后VAS评分低于术前(P<0.01)。术后SPR时间与术前Tegner评分、性别、半月板撕裂部位及软骨损伤分级相关(均P<0.05),而术后Lysholm评分则与术前Tegner评分、性别、半月板撕裂部位及半月板撕裂类型相关(均P<0.05)。多变量回归分析结果显示较长的术后SPR时间与女性和外侧半月板撕裂相关(均P<0.05),而术后较低的L.ysholm评分则与女性和术前较低的Tegner评分相关(均P<0.05)。结论关节镜下半月板部分切除术可明显改善术后第1年的膝关节功能及疼痛。术后膝关节功能较差及康复期延长与女性、外侧半月板撕裂和较差的术前膝关节功能评分相关。Objective To determine factors related to one-year efficacy of arthroscopic partial meniscectomy （APM）. Methods Eighty two patients, who underwent APM from July 2012 to March 2014, were followed up for one year. The time interval of significant pain relief （SPR）, the Lysholm score and Tegner score at the last follow-up were evaluated. The correlation of the preoperative variables and intra-operative arthroscopy findings with the clinical outcomes was analyzed with multiple regression. Results Sixty five patients （79%） were satisfied with the operation. The mean time interval of SPR was 3.3± 1.8 months. The arthroscopic examinations showed that most of patients had medial meniscus tear, degenerative meniscal tear or grade II cartilage injury. The preoperative Lysholm score was significantly lower than that after operation （P〈0.01）, while preoperative VAS scores were significantly higher than that after operation（P〈0.01）. The time interval of SPR was correlated with preoperative Tegner score, gender, site of the cartilage injury, meniscus injury grading （all P values 〈0.05）. The postoperative Lysholm score was correlated with preoperative Tegner score, gender, location of the meniscal tear and type of meniscal tear （all P values 〈0.05）. Multivariate stepwise regression analysis showed that compared to medial meniscal tears, the lateral meniscal tears and female sex were correlated with longer recovery （all P values 〈0.05）. In addition, females and patients with the lower preoperative Tegner score were correlated with the lower post-operative Lysholm score （all P values 〈0.05）. Conclusion APM can improve function and relief pain of knee joint at the first year post-operatively. Female sex, lateral meniscal tear and the lower preoperative Lysholm score are associated with worse post-operative function and longer rehabilitation time.

关 键 词：膝关节功能 半月板撕裂 疼痛 关节镜下半月板部分切除术 预后因素 

分 类 号：R687.4[医药卫生—骨科学]