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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 171 -177. doi: 10.3877/cma.j.issn.1674-134X.2021.02.007

所属专题: 文献

临床论著

两种方法治疗退行性内侧半月板后根部损伤疗效比较
周慧文1, 徐永胜1,(), 包呼日查1, 魏宝刚1, 齐岩松1, 吴海贺1, 吕飞1, 张鹏飞1, 胡永恒1   
  1. 1. 010017 呼和浩特,内蒙古自治区人民医院骨关节科
  • 收稿日期:2019-09-19 出版日期:2021-04-01
  • 通信作者: 徐永胜
  • 基金资助:
    国家自然科学基金地区科学基金项目(81560374); 内蒙古自治区人民医院博士科研启动基金(BS201518)

Comparison of two different treatment methods for degenerative medial meniscus posterior root tears

Huiwen Zhou1, Yongsheng Xu1,(), Huricha Bao1, Baogang Wei1, Yansong Qi1, Haihe Wu1, Fei Lyu1, Pengfei Zhang1, Yongheng Hu1   

  1. 1. Department of orthopedics, Inner Mongolia People’s Hospital, Hohhot 010017, China
  • Received:2019-09-19 Published:2021-04-01
  • Corresponding author: Yongsheng Xu
引用本文:

周慧文, 徐永胜, 包呼日查, 魏宝刚, 齐岩松, 吴海贺, 吕飞, 张鹏飞, 胡永恒. 两种方法治疗退行性内侧半月板后根部损伤疗效比较[J/OL]. 中华关节外科杂志(电子版), 2021, 15(02): 171-177.

Huiwen Zhou, Yongsheng Xu, Huricha Bao, Baogang Wei, Yansong Qi, Haihe Wu, Fei Lyu, Pengfei Zhang, Yongheng Hu. Comparison of two different treatment methods for degenerative medial meniscus posterior root tears[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(02): 171-177.

目的

对比分析关节镜下半月板成形术与保守治疗对退行性内侧半月板后根部损伤(MMPRTs)的临床疗效。

方法

收集2008年1月至2013年12月间内蒙古自治区人民医院收治的退行性MMPRTs患者,排除Kellgren-Lawrence分级(K-L分级)4级、非单纯性MMPRTs以及随访期不足5年患者。最终纳入53例(45~65岁),其中关节镜下半月板成形术治疗组26例,保守治疗27例。经5年随访后,根据国际膝关节评分委员会(IKDC)评分、Lysholm评分、K-L分级,以及直至末次随访为止接受全膝人工关节置换术(TKA)的比例,比较两组患者的临床疗效,并分析成形组中临床疗效欠佳患者的影响因素。术前术后评分比较采用t检验,计数资料组间比较采用卡方检验,组内各项风险因素进行COX回归分析,关节生存率比较采用Kaplan-Meier生存分析。

结果

关节镜下半月板成形术后26例患者随访5年以上,平均(7.6±2.3)年。末次随访平均IKDC评分为(58.7±12.4)分,平均Lysholm评分为(63.9±21.5)分,且34.6%(9/26)患者在末次随访时膝骨关节炎发生不同程度进展(K-L分级≥Ⅱ级),其中30.8%(8/26)患者在术后5年内接受了TKA手术。成形组与保守组相比,术后IKDC评分,Lysholm评分、K-L分级,以及接受TKA手术治疗的比例差异均无统计学意义(均为P>0.05)。接受成形术的患者中,女性患者最终的IKDC评分为(48.5±16.2)、男性为(58.2±11.8),差异无统计学意义(P>0.05)。女性[比值比(OR)=1.351,95%置信区间(CI)(1.062,2.003),P=0.029]、BMI较高[OR=0.143,95%CI(0.016,1.283),P=0.022]、膝内翻[OR=2.003,95%CI(1.131,6.461),P=0.035]、术前K-L分级[OR=2.051,95%CI(1.272,5.314),P=0.003]与半月板外凸[OR=0.105,95%CI(0.011,1.051),P=0.045]等多因素与末次随访时骨关节炎进展存在相关性。

结论

单纯行关节镜下半月板成形术治疗MMPRTs相比保守治疗而言不能有效延缓骨关节炎进展,女性、BMI增高、膝内翻以及半月板外凸这些风险因素与其预后不良有关。

Objective

Toevaluate the clinical efficacy of arthroscopic partial meniscectomy to treat degenerative medial meniscus posterior root tears (MMPRTs) compared to a matched group of conservative treated MMPRTs.

Methods

From January 2008 to December 2013, 53 patients (age 45 to 65 years) with degenerative MMPRTs treated in Inner Mongolia People’s Hospital were enrolled in this study, including 26 patients underwent arthroscopic partial meniscectomy and 27 patients received conservative treatment. The patients with K-L grade four, non-simple MMPRTs or a follow-up period of less than five years were excluded. The IKDC score, Lysholm score, Kellgren-Lawrence (K-L)grade and the ratio of total knee arthroplasty (TKA) at five years postoperatively were used for clinical evaluation. Clinical and radiographic outcomes were compared between the two groups. Analysis was performed to determine risk factors for poor clinical and radiographic outcome in the arthroscopic partial meniscectomy group alone. Preoperative and postoperative scores were compared by t test, count data were compared by chi-square test, each risk factor within the group was subjected to COX regression analysis. Joint survival rate was compared by Kaplan-Meier survival analysis.

Results

Twenty-six patients who underwent arthroscopic partial meniscectomy were followed for at least five years, (7.6±2.3) years on anverage. The final IKDC score was (58.7±12.4), Lysholm score was (63.9±21.5), and nine of the 26 patients(34.6%) had grade Ⅱ or higher level arthritis at the final follow-up than baseline. The knee osteoarthritis radiographic progression was 34.6%(8/26), and eight of the 26 patients (30.8%) were treated the operative progression by TKA. There was no significant difference in final IKDC scores, Lysholm score, K-L grades, progression to arthroplasty, or TKA rate between the arthroscopic partial meniscectomy group and conservative group (all P>0.05). In the arthroscopic partial meniscectomy group, the female patients had lower final IKDC scores (48.5±16.2) compared to the males (58.2±11.8), but there was no significant difference(P>0.05). Higher BMI[odds ratio(OR)=0.143, 95% confidence interval(CI)(0.016, 1.283), P=0.022], varus malalignment[OR=2.003, 95%CI(1.131, 6.461), P=0.035], preoperative K-L grade[OR=2.051, 95%CI(1.272, 5.314), P=0.003]and meniscal extrusion[OR=0.105, 95%CI(0.011, 1.051), P=0.045] was associated with higher rate of arthritis at final follow-up.

Conclusions

Compared with conservative treatment, arthroscopic partial meniscectomy for degenerative MMPRTs provides no benefit in delaying the progression of osteoarthritis. Female gender, increased BMI, and meniscus extrusion may associate with worse outcome.

图1 退行性内侧半月板后根部损伤典型MRI表现
表1 成形组与保守组基线数据比较
表2 成形组与保守组术后末次随访时患膝关节功能评分及K-L分级评价比较
图2 保守治疗与半月板成形术治疗膝骨关节炎的Kaplan-Meier生存分析
表3 成形组内对各风险因素进展率进行比较(n=26)
表4 成形组内对各风险因素COX回归分析
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