摘要
目的探讨关节镜下内侧半月板后角成形术延缓外伤性内侧半月板后角撕裂患者膝骨关节炎进展的价值。方法回顾性队列研究。纳入2020年4月—2022年4月南京江北医院96例外伤性内侧半月板后角撕裂患者的临床资料,其中男45例、女51例,年龄46~70(57.0±7.2)岁,左侧46例、右侧43例、双侧7例。根据患者的治疗方法进行分组:保守组46例,均采用保守治疗;手术组50例,均行关节镜下半月板成形术。分析比较2组患者治疗前、治疗后6个月、治疗后12个月的膝关节屈曲度(ROM)、Lysholm评分、纽约特种外科医院膝关节评分(HSS)、Kellgren-Lawrence(K-L)关节炎分级、胫骨远端内侧软骨国际软骨研究学会(ICRS)评分。结果手术组与保守组患者年龄、性别、损伤侧别等基线资料比较,差异均无统计学意义(P值均>0.05)。治疗前2组间患者膝关节ROM、Lysholm评分、HSS评分、K-L分级、胫骨远端内侧软骨ICRS评分比较,差异均无统计学意义(P值均>0.05)。96例患者治疗后均获随访12~19(15.1±2.1)个月,均未发生并发症。组内比较:治疗后6、12个月2组患者ROM、HSS、Lysholm评分均较治疗前明显改善,治疗后12个月HSS、Lysholm评分较治疗后6个月均进一步改善,差异均有统计学意义(P值均<0.05);2组K-L分级、ICRS评分均低于治疗前,其中,手术组治疗前与治疗后比较、治疗后不同时间点比较差异均无统计学意义(P值均>0.05),保守组差异均有统计学意义(P值均<0.05)。组间比较:治疗后6、12个月,手术组患者的ROM、HSS、Lysholm评分均较保守组高[ROM分别为131.0°±13.7°、116.5°±15.1°,135.8°±12.9°、121.3°±13.7°;HSS分别为(86.8±3.8)分、(64.7±2.9)分,(90.5±3.5)分、(69.6±2.6)分;Lysholm评分分别为(75.4±4.2)分、(60.3±4.0)分,(86.3±5.4)分、(64.8±3.7)分],而K-L分级和ICRS评分均比保守组低,差异均有统计学意义(P值均<0.05)。结论关节镜下半月板成形术能有效延缓外伤性内侧半月板后角撕裂患者膝骨关节炎的进展,且能有效改善膝关节功能和活动度。
Objective This study aimed to investigate the curative effect of arthroscopic meniscoplasty in delaying knee osteoarthritis progression in patients with traumatic tear in the posterior horn of the medial meniscus.Methods A retrospective study was conducted on 96 patients with traumatic tear in the posterior horn of the medial meniscus who received conservative treatment or arthroscopic meniscoplasty in our hospital from April 2020 to April 2022.Among the patients,45 were men and 41 were women with an age range of 46-70(57.0±7.2).A total of 46 patients complained about left knee injury;43 patients came with right knee injury,and seven complained about injury on both sides.Patients were divided into the conservative treatment group(46 patients)and surgical treatment group(50 patients).The knee range of motion(ROM),the Lysholm score,hospital for special surgery(HSS)knee score,Kellgren-Lawrence classification(K-L),and international cartilage research society(ICRS)magnetic resonance imaging cartilage grade for lateral far posterior femoral condyles were compared after pre-treatment,6 months and 1 year after treatment.Results The 96 patients were followed up for 12-19(15.1±2.1)months,and no complications occurred after treatment.There was no significant difference in baseline data such as age,gender,and injury side between the surgery group and the conservative group(all P values>0.05).No significant difference in the pre-treatment ROM,Lysholm score,HSS score,K-L classification,and ICRS score was found between the two groups(all P values>0.05).The ROM,HSS and Lysholm scores of the two groups were significantly improved at 6 months and 12 months after treatment,and the differences were statistically significant(all P values<0.05).Compared with 6 months after treatment,the HSS and Lysholm scores of the two groups were further improved at 12 months after treatment(all P values<0.05).For treatment evaluation after 6 months and 1 year,the ROM,HSS,and Lysholm scores of the surgical group were higher than those of the conservative group(ROM were 131.0°±13.7°vs.116.5°±15.1°,135.8°±12.9°vs.121.3°±13.7°,respectively;HSS were 86.8±3.8 vs.64.7±2.9,90.5±3.5 vs.69.6±2.6,respectively;Lysholm scores were 75.4±4.2 vs.60.3±4.0,86.3±5.4 vs.64.8±3.7,respectively),and K-L grade and ICRS score were lower than those in conservative group,and the differences were statistically significant(all P values<0.05).Conclusion The use of arthroscopic meniscoplasty for the treatment of traumatic tear in the posterior horn of medial meniscus has a favorable curative effect;this treatment does not only improve knee joint function and flexion,but also delay the progression of knee osteoarthritis.
作者
徐士刚
王斌
张磊
邱福平
吴飞
江起庭
Xu Shigang;Wang Bin;Zhang Lei;Qiu Fuping;Wu Fei;Jiang Qiting(Department of Orthopedics,Nanjing Jiangbei Hospital,Nanjing 210048,China)
出处
《中华解剖与临床杂志》
2024年第6期399-404,共6页
Chinese Journal of Anatomy and Clinics
关键词
半月板
胫骨
骨关节炎
膝
骨关节炎进展
外伤性内侧半月板后角撕裂
关节镜下半月板成形术
临床疗效
Menisci,tibial
Osteoarthritis,knee
Progression of osteoarthritis
Traumatic tear in posterior horn of medial meniscus
Arthroscopic meniscoplasty
Curative effect
