基于损伤分型及相应手术策略治疗外侧半月板前角-前体部撕裂的临床效果  

The Clinical Efficacy of Treating Lateral Meniscus tears in the Anterior Horn and Anterior Body Based on Injury Classification and Corresponding Surgical Strategies

作　　者：孟庆阳[1] 史尉利 冯琳[1] 虞连奎 高鑫 马勇[1] Meng Qingyang;Shi Weili;Feng Lin;Yu Liankui;Gao Xin;Ma Yong(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Engineering Research Center of Sports Trauma Treatment Technology and Devices,Ministry of Education,Beijing 100191,China;Department of Orthopedics,People's Hospital of Liaocheng City,Liaocheng 252000,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,运动创伤治疗技术与器械教育部工程研究中心,北京100191 [2]聊城市人民医院骨科,山东252000

出　　处：《中国运动医学杂志》2023年第3期173-177,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:总结外侧半月板前角-前体部损伤的临床分型及相应手术策略并评估治疗效果。方法:回顾性分析2020年1月至2020年12月收治的87例外侧半月板前角-前体部损伤患者病例资料,总结撕裂类型和手术策略,根据术前和末次随访的国际膝关节评分委员会(IKDC)评分和Lysholm膝关节评分评估治疗效果。结果:前角-前体部损伤占所有外侧半月板损伤的10.8%。依据撕裂类型将外侧半月板前角-前体部损伤分为5型,其中Ⅰ型为复合撕裂,表现为水平撕裂合并某一层垂直撕裂,并根据垂直撕裂的部位分为Ⅰa、Ⅰb、Ⅰc三种亚型;Ⅱ型为水平撕裂;Ⅲ型为垂直撕裂,并根据移位情况和形态分为Ⅲa、Ⅲb、Ⅲc三种亚型;Ⅳ型为松散型,发生在前角;Ⅴ型为缺失型,半月板前角-前体部消磨殆尽。对于常规手术入路无法处理的Ⅰb型和Ⅱ型损伤,附加外下入路进行操作并视情况进行Outside-in缝合。87例患者均获得随访,平均随访25.1±5.7月(19~31月)。末次随访时IKDC评分和Lysholm评分均显著高于术前(分别为64.5±7.4 vs 84.3±6.9和73.3±5.1 vs 90.1±5.0,均P<0.05)。结论:基于不同分型采取相应手术策略是治疗外侧半月板前角-前体部损伤的有效方法。Objective To summarize the classification and surgical strategies for anterior horn and anterior body injuries of lateral meniscus,and evaluate its clinical efficacy.Methods Eighty-seven patients with anterior horn and anterior body injuries of lateral meniscus and treated in our hospital in year 2020 were analyzed their clinical data retrospectively.The classification of their tears and surgical strategiesweresummarized.Moreover,their clinical efficacy was evaluated using the International Knee Scoring Committee(IKDC)scores and Lysholm scores preoperatively and at the last follow-up.Results Anterior horn and anterior body tears accounted for 10.8%of all lateral meniscus injuries.As to the tear type,the anterior horn and anterior body tears of lateral meniscus could be divided into 5 types:TypeⅠinjuries were compound tears characterized by horizontal tears combined with a vertical tear,which were further divided into Ⅰa,Ⅰb,Ⅰc subtypes according to its location;Type Ⅱ injuries were horizontal tears;Type Ⅲ were vertical tears which were further divided into Ⅲa,Ⅲb and Ⅲc subtypes according to displacement and morphology of lateral meniscus;Type Ⅳ injuries were those scattering in the anterior horn;Type Ⅴ injuries were the deletion type characterized with the absence of the anterior horn and body.For type Ⅰb and typell injuries that could not be handled by conventional surgical approach,the procedure can be performed with an additional external-inferior approach and outside-in sutures if necessary.All 87 patients were followed up for an average of 25.1±5.7 months(19~31 months).The average IKDC and Lysholm scores at the last follow-up were significantly higher than preoperative ones(64.5±7.4 vs 84.3±6.9;73.3±5.1 vs 90.1±5.0,P<0.05,respectively).Conclusion For anterior horn and body injuries of lateral meniscus,surgical strategies should be chosen according to different classifications.

关 键 词：半月板损伤 外侧半月板 半月板前角 半月板前体部 分型 

分 类 号：R687.4[医药卫生—骨科学]