盘状半月板切除术对中老年患者下肢力线的早期影响  

Short-term effects of discoid lateral meniscectomy on axial alignment of lower limb in middle-aged patients

作　　者：李明[1] 刘华[1] 章云峰[1] 狄正林[1] 章军辉[1] 何志勇[1] LI Ming;LIU Hua;ZHANG Yun-feng;DI Zheng-lin;ZHANG Jun-hui;HE Zhi-yong(Deportment of Joint Surgery, Ningbo N0.6 Hospital, Ningbo, Zhejiang 315040, China)

机构地区：[1]宁波市第六医院关节外科,浙江315040

出　　处：《中国骨与关节损伤杂志》2018年第6期575-578,共4页Chinese Journal of Bone and Joint Injury

基　　金：宁波市自然科学基金项目(2017A610179)

摘　　要：目的探讨关节镜下盘状半月板切除术后下肢力线的早期改变情况。方法纳入自2016-09—2017-05术前诊断为盘状半月板损伤且站立时膝关节能伸直的40例中老年患者作为研究对象。盘状半月板部分切除成形19例(A组),其中16例缝合修复,3例未修复。盘状半月板次全切除成形15例(B组),其中6例缝合修复,未修复9例。盘状半月板全部切除6例(C组)。分别于术前及术后1 d摄双下肢全长负重位X线片,测量并比较股胫角、机械轴偏移、外侧关节间隙。结果与术前相比,术后3组的股胫角、机械轴偏移和外侧关节间隙均发生明显改变,差异有统计学意义(P<0.05)。A组手术前后股胫角、机械轴偏移和外侧关节间隙差值的绝对值均小于B组和C组,差异有统计学意义(P<0.05);而B组手术前后股胫角、机械轴偏移和外侧关节间隙差值的绝对值与C组相比差异无统计学意义(P>0.05)。结论外侧盘状半月板切除术后即刻下肢力线即发生改变,主要表现为膝内翻减轻和膝外翻增加,而半月板切除量的增加导致下肢力线的改变程度也相应增加。术前应加强对下肢力线的评估,术中尽量保留和修复损伤的半月板。Objective To evaluate the short-term influence of arthroscopic meniscectomy of the discoid lateral meniscus on the axial alignment of the lower limb. Methods From September 2016 to May 2017, the data from 40 middle-aged patients who were diagnosed with discoid meniscus injury were retrospectively reviewed. Nineteen cases of discoid meniscus were partially removed （group A）, of which 16 cases were repaired with suture and 3 cases were not repaired. Fifteen cases of discoid meniscus subtotal resection （group B） were performed, of which 6 cases were repaired with suture, and 9 cases were not repaired. Six cases of discoid meniscus were totally removed （group C）. Full weight bearing X-rays were done before and one day after arthroseopy. The tibio-femoral angle （TFA）, mechanical axis deviation （MAD） and lateral joint space （LJS） were examined on standing anteroposterior radiographs before and one day after arthroseopy. Results Compared with those before operation, TFA, MAD and LJS were significantly changed in the 3 groups after the operation, and the difference was statistically significant （P 〈0.05）. The absolute value change of TFA, MAD and LJS of group A before and after operation was less than that of group B and group C, the difference was statistically significant （P 〈0.05）. There were no significant differences in the change of TFA, MAD and LIS between group B and group C before and after the operation （P 〉0.05）. Conclusion The axial alignment of the lower limb in patients with a torn discoid lateral meniscus is altered immediately after arthroscopic meniscectomy： the varus deformity is significantly reduced, and a valgus inclination is developed in some of these patients. With the increase in meniscus resection, lower limb force line changes increase correspondingly. Attention should be paid to the evaluation of preoperative axial alignment of the lower limb in patients with discoid meniscus.

关 键 词：盘状半月板 关节镜 半月板部分切除术 半月板次全切除术 半月板全切除术 下肢力线 

分 类 号：R684[医药卫生—骨科学]