关节镜下半月板成形术与康复训练治疗中年退行性内侧半月板撕裂的疗效比较  

Comparison of effect of arthroscopic meniscoplasty and rehabilitation training in the treatment of middle-aged degenerative medial meniscus tear

作　　者：韩伟峰[1] 王典 陈艺丹 曾峥[1] Weifeng Han;Dian Wang;Yidan Chen;Zheng Zeng(Department of Orthopaedic Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Operation room,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院骨科,100070 [2]首都医科大学附属北京天坛医院手术室,100070

出　　处：《中华损伤与修复杂志（电子版）》2024年第2期134-140,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：高层次公共卫生技术人才建设项目培训计划(学科骨干-01-049)。

摘　　要：目的对比分析关节镜下半月板成形术与康复治疗中年单纯退行性膝内侧半月板撕裂的临床疗效。方法回顾性分析2017年1月至2020年1月首都医科大学附属北京天坛医院骨科收治的90例中年内侧半月板撕裂患者资料,依据不同治疗方式,分为半月板成形组(48例),康复治疗组(42例),于术前、术后3个月、术后2年采集患者一般情况、膝关节功能评分量表(KOOS)、膝关节影像学评估(KL分级),比较两组患者的临床疗效。结果半月板成形组与康复治疗组在年龄、性别、体质量指数(BMI)方面组间差异无统计学意义;半月板成形组术前KOOS评分[(36.61±7.14)分]与康复治疗组[(36.7±11.59)分]相比差异无统计学意义;半月板成形组术后3个月KOOS评分[(64.3±14.39)分]显著高于康复治疗组[(44.65±1.66)分](P<0.05);半月板成形组术后2年KOOS评分[(71.2±14.37)分]与康复治疗组[(72.7±12.15)分]相比差异无统计学意义;术后2年膝骨关节炎进展半月板成形组(术前KL 0级3例,1级24例,2级21例;术后2年0级0例,1级12例,2级36例)显著快于康复治疗组(治疗前KL 0级4例,1级18例,2级20例;治疗后2年0级0例,1级16例,2级26例)(P<0.05)。结论相对于康复治疗方案,单纯退行性膝内侧半月板撕裂患者接受半月板成形术在早期可显著改善临床症状和膝关节功能,尤其是疼痛和日常生活能力,在中期临床随访中无显著差异,半月板成形术加速膝骨关节炎进展。与康复治疗相比,关节镜下半月板成形术治疗退行性膝内侧半月板撕裂并无明显优势,应采取谨慎态度。Objective To compare and analyze the clinical effect of arthroscopic meniscoplasty and rehabilitation therapy on middle-aged patients with simple degenerative medial meniscus tear.Methods Retrospectively analyzed 90 middle-aged patients with medial meniscus tear admitted to Department of Orthopaedic Surgery in Beijing Tiantan Hospital,Capital Medical University from January 2017 to January 2020.According to the different treatment methods selected by the patients,48 patients were divided into meniscus repair group and 42 patients were rehabilitated treatment group.The general condition,KOOS,and knee imaging evaluation(KL)were collected before surgery,3 months and 2 years after surgery,and the clinical effects of the two groups were compared.Results There were no differences in age,sex and body mass index between meniscus repair group and rehabilitation treatment group.There was no difference between the preoperative KOOS score(36.61±7.14 VS 36.7±11.59).The KOOS score(64.3±14.39)in the meniscus group was significantly higher than that in the rehabilitation treatment group(44.65±1.66)3 months after surgery(P<0.05).There was no difference in KOOS score between the meniscus repair group and rehabilitation group(71.2±14.37 VS 72.7±12.15)2 years after surgery.The progress of knee osteoarthritis was significantly obvious in meniscus repair group(3 cases in KL grade 0,24 cases in grade 1,21 cases in grade 2 before surgery;0 cases in grade 0,12 cases in grade 1 and 36 cases in grade 2 in 2 years after surgery)than that in the rehabilitation treatment group(4 cases in grade 0,18 cases in grade 1 and 20 cases in grade 2 before treatment;0 cases in grade 0,16 cases in grade 1 and 26 cases in grade 2 in 2 years after treatment).Conclusion Compared with rehabilitation treatment,meniscus repair can significantly improve the clinical symptoms and knee function,especially pain and daily living ability in the early stage.There is no significant difference in the mid-term clinical follow-up.Meniscus repair accelerates the pro

关 键 词：半月板撕裂 膝关节镜 半月板成形 康复 

分 类 号：R687.4[医药卫生—骨科学]