同种异体半月板移植术治疗外侧盘状半月板与非盘状半月板损伤疗效对比研究  

Comparison of efficacy of meniscus allograft transplantation between discoid lateral meniscus and nondiscoid lateral meniscus

作　　者：任士友 李子键 尤田[1] 江小成 张新涛[1] 李伟[1] 白露[1] 张文涛[1] REN Shiyou;LI Zijian;YOU Tian;JIANG Xiaocheng;ZHANG Xintao;LI Wei;BAI Lu;ZHANG Wentao(Centre of Sports Medicine and Rehabilitation,Peking University Shenzhen Hospital,Shenzhen 518036,Guangdong,China)

机构地区：[1]北京大学深圳医院运动医学与康复医学中心,广东深圳518036

出　　处：《中华骨与关节外科杂志》2021年第12期1016-1021,共6页Chinese Journal of Bone and Joint Surgery

基　　金：深圳市三名工程项目基金(SZSM201612078);北京大学深圳医院院内课题(LLYJ2020005)。

摘　　要：目的:比较同种异体半月板移植术治疗外侧盘状半月板与外侧非盘状半月板严重损伤的临床疗效。方法:采用回顾性研究分析2005年1月至2017年12月行外侧半月板移植手术的106例患者资料,其中盘状半月板组59例和非盘状半月板组47例。所有患者均完成2年及以上随访。通过测定关节活动度(ROM),使用视觉模拟评分(VAS)、国际膝关节委员会评分(IKDC)、Lysholm评分、Tegner评分进行临床评估。术前和术后随访进行磁共振(MRI)检查评估移植物及软骨状况。结果:术前盘状半月板组与非盘状半月板组ROM、IKDC评分、Lysholm评分、Tegner评分和VAS评分差异均无统计学意义(P>0.05)。与术前比较,末次随访盘状半月板组与非盘状半月板组上述临床指标(除ROM外)均有改善(P<0.05)。对末次随访功能评分分析表明,非盘状半月板组IKDC评分、Lysholm评分、VAS评分优于盘状半月板组,而两组Tegner评分差异无统计学意义。随访MRI检查显示,盘状半月板组移植物外移距离为(3.65±0.71)mm,非盘状半月板组移植物外移距离为(3.07±0.85)mm,差异有统计学意义(P<0.05)。两组移植物损伤程度比较差异无统计学意义(P>0.05)。结论:同种异体半月板移植术对严重外侧盘状半月板损伤、非盘状半月板损伤均有明显治疗效果,能明显提高膝关节的功能。同种异体半月板移植术治疗非盘状半月板疗效明显优于盘状半月板,其原因仍需进一步研究,在临床中应对患者给予告知。Objective: To compare the clinical results of meniscus allograft transplantation(MAT) between patients with discoid lateral meniscus(DLM)and patients with nondiscoid lateral meniscus(NDLM). Methods: A total of 106 patients with lateral discoid meniscus or lateral nondiscoid meniscus who underwent unilateral MAT from January 2005 to December 2017 were included in the study. All patients were followed up for at least two years. Clinical outcomes were assessed by range of motion(ROM), visual analogue scale(VAS), International Knee Documentation Committee(IKDC) subjective score, Lysholm score and Tegner activity score. Magnetic resonance imaging was performed to evaluate the condition of plant and cartilage. Results:There was no significant difference in ROM, IKDC, Lysholm, Tegner and VAS before the operation between DLM group and NDLM group(P>0.05). Except for ROM, the above clinical evaluation indexes were improved at final follow-up visit compared with that before operation in both groups(P<0.05). According to functional scores of final follow-up visit, IKDC,Lysholm and VAS were better in NDLM group than in DLM group, while Tegner score had no statistically significant difference between the two groups. The mean meniscal extrusion was(3.653±0.705) mm in DLM group and(3.074±0.850) mm in NDLM group, and the difference was not statistically significant(P>0.05).Conclusions: MAT is effective in treatment of both serious lateral discoid meniscus injury and lateral nondiscoid meniscus injury with knee function significantly improved,however, the efficacy of the latter is better than that of the former. The reason is still required further study and the difference should be informed to the patients.

关 键 词：同种异体半月板移植术 盘状半月板 非盘状半月板 比较研究 

分 类 号：R687.3[医药卫生—骨科学]