天津医药

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关节镜治疗儿童盘状半月板损伤的疗效分析

王增亮1,赵力2,杨建平3,赵金岩4   

  1. 1. 天津市天津医院
    2. 天津医院
    3. 天津市天津医院小儿骨科
    4. 天津市天津医院关节镜科
  • 收稿日期:2011-08-08 修回日期:2011-10-13 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 王增亮

  • Received:2011-08-08 Revised:2011-10-13 Published:2011-12-15 Online:2011-12-15

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摘要： 【摘要】目的：探讨关节镜下行半月板成形术治疗儿童盘状半月板的临床疗效。方法：2003年1月至2009年4月，共收治儿童盘状半月板损伤患者31例(33膝)，其中男18例，女13例。左膝9例，右膝20例，双膝2例，（其中一例为双膝内侧盘状半月板损伤）。本组患儿年龄4～14岁，平均11.3岁。本组患儿术前症状包括：关节间隙压痛(20例)、活动痛(13例)、麦氏征阳性(25例)，Apley征阳性（14例），关节绞锁(11例)，跛行(31例)，屈曲畸形（23例）,股四头肌萎缩(29例)。从患儿症状出现至治疗时间为半个月至3.5年，平均（8.2±1.5）个月。膝关节功能采用Lysholm评分标准进行评价。结果：所有患者均行关节镜下半月板部分切除成形或次全切除术。术中33膝均被证实为盘状半月板，按Watanabe关节镜下盘状半月板分型，其中完全型27膝，不完全型4膝，2膝为Wrisberg韧带型。术后患者症状均得到明显改善。患者伤口均无感染，愈合良好。术后随访12-24个月。术前Lysholm平均51.8±2.6分(35-66)，术后12个月Lysholm平均92.5±1.7分(79-95)，术前术后Lysholm评分具有明显统计学差异（p<0.05）。没有发现再撕裂和需要再次手术治疗的患者。结论：应用半月板成形术治疗儿童盘状半月板具有较好的临床效果，具有损伤小、住院时间短、术后康复快和并发症少等优点，可以作为其手术选择方案之一。

关键词: 儿童, 盘状半月板, 关节镜, 半月板成形术

Abstract: 【Abstract】 Objective: To investigate the clinical curative effect of arthroscopic meniscus plasty on discoid meniscus in children. Methods: From January 2003 to April 2009, 31 children ( 33 knees ) with discoid meniscus injury were treated in our hospital, including 18 males and 13 females, with 9 cases in left knee, 20 cases in right knee and 2 cases in both knees.This group of children aged 4 to 14 years old , with an average of 11.3 years old. This group of pediatric patients with preoperative symptoms included: tenderness in joint gap (20 cases), pain on motion (13 cases), positive McMurray sign (25 cases), positive Apley sign (14 cases), joint interlocking ( 11 cases ), claudication ( 31 cases), flexion deformity (23 cases), and quadriceps atrophy (29 cases). The duration between appearance of symptoms and visiting a doctor was from half a month to 3.5 years, with an average of (8.2+1.5) months. The function of knee joint was evaluated according to Lysholm scorcing system. Results: All 31 patients (33 knees) underwent arthroscopic partial meniscectomy plasty or subtotal resection and 33 knees were confirmed as discoid meniscus. According to Watanabe typing system, there were complete type in 27 knees, incomplete type in 4 knees and Wrisberg ligament type in 2 knees. Preoperative symptoms of all patients were obviously improved. The wound of the patient healed well, with no infection. All patients were followed up 12 to 24 months. Preoperative mean Lysholm score was (51.8 + 2.6) points (range, 35-66 points), and the Lysholm mean score was (92.5 + 1.7) points (range, 79-95 points) at 12 month after operation. There were significantly statistical difference between preoperative and postoperative Lysholm score ( P < 0.05 ). Menisci tear and patient needs the second surgery were not found during the follow-up. Conclusion: Meniscus plasty applied in the treatment of discoid meniscus in children has good clinical effect, with many advantages such as a little injury, short hospitalization time, faster postoperative recovery and less complication etc., and can be used as one of the treatment methods.