摘要
目的探讨膝关节骨性关节炎镜下半月板特征及其对微创手术治疗的指导意义。方法根据关节镜下半月板损伤及其对周围滑膜、关节软骨的影响程度分为4型：Ⅰ型，半月板局限性损伤；Ⅱ型，局限性损伤合并磨损性损伤；Ⅲ型，损伤涉及半月板大部甚至整体，半月板松动；Ⅳ型，半月板磨损合并部分或大部缺如。各型损伤均采用相对应的镜下半月板手术治疗。结果Ⅰ型半月板损伤10例，Ⅱ型20例，Ⅲ型27例，Ⅳ型11例。Ⅰ型损伤：4例行缝合修复手术，6例行镜下半月板部分切除术；Ⅱ型：镜下部分切除18例，次全切除2例；Ⅲ型：清理刨削1例，镜下部分切除5例，次全切除16例，全切除5例；Ⅳ型：次全切除2例，全切除9例。随访平均22个月（6—52个月），劳累后痛7例（Ⅱ型1例，Ⅲ型2例，Ⅳ型4例）；绞锁1例（Ⅲ型）；关节屈曲受限2例（Ⅲ型1例，Ⅳ型1例）。3例（Ⅲ型2例、Ⅳ型1例）术后2—3年行全膝关节置换术，其余65例Lysholm评分：术前50±12，术后随访时85±8（t=3．521，P〈0．01）。结论膝关节骨性关节炎半月板损伤具有一定的镜下特征。膝关节骨性关节炎半月板损伤的镜下分型有助于指导镜下手术，提高膝关节骨性关节炎微创手术治疗的效果。
Objective To investigate arthroscopic characteristics and minimally invasive treatment of meniscal injuries in osteoarthritic knees. Methods Sixty-eight cases of meniscal injuries in osteoarthritic knees were divided into four types according to arthroscopic characteristics of meniscal tears and involvement degree of the synovium and the cartilage： Type Ⅰ： limited meniscal injuries; Type Ⅱ ： Limited injuries combined with abrasive injuries; Type Ⅲ ： injuries of the most part of the meniscus, loose meniscus; Type Ⅳ： abraded meniscus combined with partial or mostly partial absence. Corresponding arthroscopic procedures were performed. Results Among the 68 cases, there were 10 cases of the Type Ⅰ injuries, 20 cases of the Type Ⅱ, 27 cases of the Type Ⅲ, and 11 cases of the Type Ⅳ, respectively. For the Type Ⅰ injuries, arthroscopic meniscal suture was performed in 4 cases and partial arthroscopic meniscectomy was performed in 6 cases. For the Type Ⅱ injuries, arthroscopic partial meniscectomy was performed in 18 cases and subtotal maniscectomy was performed in 2 cases. For Type Ⅲ injuries, arthroscopic lavage and debridement was performed in 1 case, arthroscopic partial meniscectomy in 5 cases, subtotal meniscectomy in 16 cases, and total meniscectomy in 5. For Type Ⅳ injuries, arthroscopic subtotal meniscectomy was performed in 2 cases and total meniscectomy in 9 cases. A follow-up was carried out for 6 - 52 months （ mean, 22 months）. There were 7 cases of pain after vigorous activities （ Type Ⅱ ： 1 case; Type Ⅲ： 2 cases; Type Ⅳ ： 4 cases） , 1 case of locking knee （Type Ⅲ ）, and 2 cases of limitation of knee flexion （Type Ⅲ and Ⅳ ： 1 case each）. Total knee replacement was conducted 2 - 3 years after the procedure in 3 cases （Type Ⅲ ： 2 cases; Type Ⅳ ： 1 case）. Of the remaining 65 cases, the Lysholm scores were elevated from 50 - 12 preoperatively to 85 ± 8 postoperatively （t =3. 521, P 〈0.01 ）. Conclusions Arthroscopic typing characteristics of meniscal injuries in osteoarthritic knees are helpful to improve effects of minimally invasive surgery in knee osteroarthritis.
出处
《中国微创外科杂志》
CSCD
2006年第12期903-905,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
膝
骨性关节炎
半月板
镜下特征
微创治疗
Knee
Osteoarthritis
Meniscus
Arthroscopic characteristic
Minimally invasive surgery
