基于MRI的临床分型及手术入路选择治疗内侧半月板囊肿的效果  

The Surgical Outcome of Treating Medial Meniscus Cysts According to Clinical Classification Based on MRI

作　　者：孟庆阳[1] 马勇[1] 史尉利 敖英芳[1] Meng Qingyang;Ma Yong;Shi Weili;Ao Yingfang(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学科北京大学运动医学研究所运动医学关节伤病北京市重点实验室,北京100191

出　　处：《中国运动医学杂志》2021年第10期767-771,共5页Chinese Journal of Sports Medicine

基　　金：国家自然科学基金青年项目(81802153)。

摘　　要：目的:观察根据磁共振成像(MRI)对内侧半月板囊肿进行临床分型、采取相应手术入路完全切除囊肿的治疗效果。方法:选取2015年1月~2020年1月手术治疗的52例症状性内侧半月板囊肿患者作为研究对象,基于MRI表现,将内侧半月板囊肿分型:根据囊肿是否涉及半月板内部,分为半月板外型和半月板内外型;根据囊肿与内侧半月板位置关系,分为前角型、体部型、后角型和混合型。采用常规前内和前外入路处理前角型囊肿,附加膝内侧皮下入路处理体部型囊肿,附加后内入路处理后角型囊肿,予以完整切除并避免对神经、血管等组织的损伤。通过比较术前与术后1年的疼痛视觉模拟评分(VAS)和Lysholm膝关节评分,以及术后1年复查MRI评估治疗效果。结果:内侧半月板囊肿患者中16例(30.8%)有膝关节扭伤史,42例(80.8%)合并内侧半月板撕裂,且以水平裂为主。48例(92.3%)为半月板外型,4例(7.7%)为半月板内外型。前角型10例(19.2%),体部型8例(15.4%),后角型16例(30.8%),混合型18例(34.6%)。术后1年时,患者疼痛VAS评分由术前的5.9±0.8分降至1.1±1.2分(P<0.05),Lysholm膝关节评分由术前的56.7±9.6分提高至83.8±10.3分(P<0.05)。所有患者均于术后1年完成MRI检查,未见囊肿复发。结论:基于MRI表现将内侧半月板囊肿分型,采用相应手术入路将囊肿完整切除,可以改善患者症状并避免囊肿复发,具有临床可操作性和可重复性。Objective To observer the surgical outcome of treating medial meniscus cysts according to clinical classification based on MRI.Methods Fifty-three patients with symptomatic medial meniscus cysts and receiving surgery between January 2015 and January 2020 were included in this study.According to magnetic resonance imaging(MRI),medial meniscus cysts were divided into the external type and inner-external type according to whether there were cysts inside meniscus,as well as the anterior horn type,body type,posterior horn type and mixed type according to the position of the cysts and the medial meniscus.Conventional anterior-internal and anterior-external portals were adopted to treat the anterior horn type.Meanwhile,the medial subcutaneous portal was adopted to remove cysts for the body type,and posterior-internal portals were employed for the posterior horn type.Thus,the cysts were completely removed,while nerve,blood vessel and other tissues were not damaged.All patients were evaluated using the visual analogue scale(VAS),Lysholm knee score and MRI before and1 year after the surgery.Results Among the patients,16(30.8%) had a history of knee sprain,and 42(80.8%) had medial meniscus tear,mainly horizontal tear.Moreover,48(92.3%) and 4(7.7%) were of the external and inner-external type,while 10(19.2%),8(15.4%),16(30.8%) and 18(34.6%)were of the anterior horn type,body type,posterior horn type and mixed type.The average VAS score decreased significantly from 5.9 ± 0.8 before the surgery to 1.1 ± 1.2 one year after the surgery(P<0.05),while the average Lysholm knee score increase significantly from preoperative 56.7 ± 9.6 to83.8 ± 10.3 one year after the operation(P<0.05).No recurrence of cysts was observed on MRI 1 year after the surgery.Conclusion The treatment studied can relieve patients’ symptoms and avoid the recurrence of cysts,which is of good clinical operability and repeatability.

关 键 词：内侧半月板 半月板囊肿 半月板损伤 临床分型 手术入路 

分 类 号：R687.4[医药卫生—骨科学]