切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 22 -28. doi: 10.3877/cma.j.issn.1674-134X.2022.01.004

临床论著

两种关节镜手术入路治疗外侧盘状半月板损伤的比较
华强1, 张瑞1, 温呈洪1, 任洁1, 钱文多1, 雷鸣鸣1,†()   
  1. 1. 610041　成都体育学院附属体育医院运动医学关节镜科
  • 收稿日期:2020-07-20 出版日期:2022-02-01
  • 通信作者: 雷鸣鸣
  • 基金资助:
    四川省中医药管理局科学技术研究专项课题(2021MS343)

Comparison of two arthroscopic operative portals for lateral discoid meniscus injuries

Qiang Hua1, Rui Zhang1, Chenghong Wen1, Jie Ren1, Wenduo Qian1, Mingming Lei1,†()   

  1. 1. Department of Orthopaedic Sports Medicine and arthroscope, the Sports Hospital Affiliated to Chengdu Sport University, Chengdu 610041, China
  • Received:2020-07-20 Published:2022-02-01
  • Corresponding author: Mingming Lei
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

华强, 张瑞, 温呈洪, 任洁, 钱文多, 雷鸣鸣. 两种关节镜手术入路治疗外侧盘状半月板损伤的比较[J/OL]. 中华关节外科杂志(电子版), 2022, 16(01): 22-28.

Qiang Hua, Rui Zhang, Chenghong Wen, Jie Ren, Wenduo Qian, Mingming Lei. Comparison of two arthroscopic operative portals for lateral discoid meniscus injuries[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(01): 22-28.

目的

对比采取常规膝前外、内侧入路和膝高位前外侧、高位极前内侧入路治疗外侧盘状半月板损伤的临床效果。

方法

选取2016年01月至2017年12月成都体育学院附属体育医院收治的膝外侧盘状半月板患者57例为研究对象，年龄≤60岁，单侧发病(Outerbridge分级<3级)，无下肢骨折及膝关节其他损伤。依据在术中手术入路的不同将其分为常规组和改良组。常规组(26例)，采取常规膝前内侧、前外侧入路进行手术；改良组(31例)，采取膝高位前外侧入路和高位极前内侧入路进行手术。记录两组患者的手术时间、关节腔内积液量，采用配对t检验和卡方检验比较术前和术后3个月的膝前视觉模拟(VAS)评分、Lysholm评分和MRI复查情况。

结果

所有患者获得随访，平均(15.1±2.1)个月，术后切口均Ⅰ级愈合。两组患者Watanabe分型比较，差异无统计学意义(P>0.05)。两组患者术后3个月Lysholm评分均较术前显著提高(常规组：t＝-19.719，P<0.05；改良组：t＝-30.094，P<0.05)，且改良组术后Lysholm评分高于常规组(P<0.05)。两组患者术前膝前VAS评分比较，差异无统计学意义(t＝ -0.255，P>0.05)，常规组患者术后3个月的膝前VAS评分较术前显著提高(t＝-9.603，P<0.05)，而改良组患者术后3个月的膝前VAS评分与术前类似(t＝-1.139，P>0.05)。常规组手术时间(t＝14.434，P<0.05)、术后关节腔积液量明显高于改良组(t＝40.989，P<0.05)。MRI复查两组患者均未出现半月板不愈合情况(χ2＝0.035，P>0.05)。

结论

两种手术入路均可完成外侧盘状半月板损伤的处理，并获得良好的的近期疗效。采取膝高位前外侧、高位极前内侧入路，镜下视野大，同时避免对髌下脂肪垫刨消，缩短手术时间，减轻患者术后膝前疼痛。

关键词: 半月板, 关节镜, 膝关节, 半月板切除术
Objective

To compare the clinical effects of arthroscopic treatments for lateral discoid meniscus injuries by the conventional anterolateral portal and anteromedial portal with the high anterolateral portal and high far anteromedial portal.

Methods

Sixty-eight patients of meniscus injury were selected from January 2016 to December 2017 in the Sports Hospital Affiliated to Chengdu Sport University, who were divided into conventional group(26 cases) and modified group (31 cases)according to the different operation portals.The conventional group adopted conventional anterolateral portal; the modified group adopted anteromedial portal with the high anterolateral portal and high far anteromedial portal.The operation time and the volume of articular cavity were recorded; the anterior knee visual analogue scales(VAS score), Lysholm score and MRI reexamination before the optration and three months after the operation were observed and compared by t test or chi square test.

Results

All the patients were followed-up (15.1±2.1) months on average. The incision of two-group patients healed at grade I. There was no statistically significant difference in Watanabe typing between the two groups (P>0.05). The Lysholm scores after the operation at three months between the two groups were all higher than those before the operation(the conventional group: t=-19.719, P<0.05; the modified group: t=-30.094, P<0.05), and the postoperative Lysholm score of the modified group was higher than that of conventional group(P<0.05). There was no significant difference of the anterior knee pain VAS score before the operation between the two groups (t= -0.255, P>0.05). The anterior knee pain VAS score of conventional group after the operation at three months was higher than those before the operation (t=-9.603, P<0.05), and the anterior knee pain VAS score of modified group after the operation at three months was similar than those before the operation (t=-1.139, P>0.05). The operation time (t=14.434, P<0.05)and the volume of articular cavity of the conventional group were higher than those of the modified group(t=40.989, P<0.05). The MRI showed that there was no meniscus nonunion in neither group (χ2=0.035, P>0.05) .

Conclusions

Both operation portals can treat lateral discoid meniscus and have good short-term effect. By the high anterolateral portal and high far anteromedial portal can enlarge the surgical field of vision, avoid gouging the infrapatellar fat pad with less operation time, and relieve the knee joint pain after operation.

Key words: Meniscus, Arthroscopy, Knee joint, Meniscectomy
表1 两组患者一般资料对比
组别 例数 性别(例) 年龄[岁，(±s)] 膝别(例) 病程[月，(±s)] BMI[kg/m2，(±s)]
男 女 左 右
常规组 26 14 12 36±8 17 9 12±6 22±4
改良组 31 17 14 36±8 19 12 11±5 22±5
统计值   χ2＝0.006 t＝0.044 χ2＝0.102 t＝0.469 t＝0.164
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组患者手术时间，关节腔内积液量比较(±s)
组别 例数 手术时间(min) 关节腔内积液量(ml)
常规组 26 52.7±6.7 40.8±2.8
改良组 31 26.3±7.0 11.2±2.6
t值   14.434 40.989
P值   <0.001 <0.001
表3 两组患者术前与术后3个月Lysholm评分比较(±s)
组别 例数 跛行 支撑 交锁 不稳定 总分
术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月
常规组 26 3.1±1.2 4.0±1.0 2.6±1.6 4.55±1.1 9.9±3.7 11.9±2.5 12.7±3.8 20.0±3.7 - -
改良组 31 3.4±1.5 4.2±1.0 2.7±1.6 4.7±0.9 11.1±4.4 13.7±2.2 12.4±4.1 22.6±2.9 - -
t值   -0.7871 -0.847 -0.233 -0.645 -1.101 -2.866 0.260 -2.954 - -
P值   >0.05 >0.05 >0.05 >0.05 >0.05 0.006 >0.05 0.005 - -
组别 例数 疼痛 肿胀 爬楼梯 下蹲 总分
术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月
常规组 26 10.2±3.3 19.2±3.4 4.2±2.0 7.1±2.1 4.6±1.9 8.2±2.0 2.2±1.5 4.7±0.5 49.5±3.9 79.8±7.1
改良组 31 11.0±3.0 23.4±3.4 3.3±1.9 9.1±1.7 4.6±1.9 8.7±1.9 2.8±1.4 4.7±0.5 51.2±5.6 91.2±6.5
t值   -0.926 -5.440 1.655 -3.978 0.067 -1.065 -1.494 -0.715 -1.359 -6.834
P值   >0.05 <0.001 >0.05 <0.001 >0.05 >0.05 >0.05 >0.05 >0.05 <0.001
表4 两组患者术前与术后3个月膝前痛VAS评分情况(±s)
组别 例数 术前 术后3个月 t值 P值
常规组 26 0.7±0.6 3.0±0.8 -9.603 <0.001
改良组 31 0.8±0.7 0.9±0.8 -1.139 0.264
t值   -0.255 9.663    
P值   >0.05 0.001    
图1 典型病例术前左膝矢状面MRI，示外侧盘状半月板损伤
图2 典型病例关节镜手术过程及术中所见。图A为术前用记号笔标记手术入路和体表骨性标志；图B示术中膝关节"4"字体位；图C为通过高位前外侧入路探查，关节镜下示外侧半月板宽大、肥厚，呈盘状；图D为关节镜监视下，建立高位极前内侧入路；图E为关节镜下修整成型后的外侧盘状半月板
图3 典型病例末次随访时左膝MRI，示外侧半月板呈正常形状，完全愈合
[1]
Yilgor C, Atay OA, Ergen B, et al. Comparison of magnetic resonance imaging findings with arthroscopic findings in discoid meniscus[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22 (2): 268-273.
[2]
Gregory AS, Peter TS. Meniscal repair in children and adolescents[J]. Sports Med Arthrosc, 2004, 12(1): 60-68.
[3]
谢威，李皓桓，张小龙，等．保留髌下脂肪垫的高位前侧入路在膝关节镜手术中的应用[J]．武汉大学学报(医学版)，2017，38(2): 293-297.
[4]
Laskin RS, Vansteinjn M. Total knee replacement for patients with patellofemoral arthritis[J]. Clin Orthop Relar Res, 1999, 3(67): 89-95.
[5]
Briggs KK, Kocher MS, Rodkey WG, et al. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee[J]. J Bone Joint Surg Am, 2006, 88(4): 698-705.
[6]
Henning CE, Clark JR, Lynch MA, et al. Arthroscopic meniscus repairwith a posterior incision[J]. Instr Course Lect, 1988, 37(2): 209-221.
[7]
Bae JH, Lim HC, Hwang DH, et al. Incidence of bilateral discoid lateral meniscus in an Asian population: an arthroscopic assessment of contralateral knees[J]. Arthroscopy, 2012, 28(7): 936-941.
[8]
Dunn J, Kusnezov N, Waterman BR, et al. Discoid medial meniscus: a case report[J]. Mil Med, 2016, 181(2): E194-E196.
[9]
Lee CH, Song IS, Jang SW, et al. Results of arthroscopic partial meniscectomy for lateral discoid meniscus tears associated with new technique[J]. Knee Surg Relat Res, 2013, 25(1): 30-35.
[10]
Kini SG, Walker P, Bruce W. Bilateral symptomatic discoid medial meniscus of the knee: a case report and review of literature[J]. Arch Trauma Res, 2015, 4(1): e27115. DOI：10.5812/atr.27115.
[11]
康明，张彦，张理选，等．关节镜下盘状半月板损伤成形缝合术的中长期疗效[J/CD]．中华关节外科杂志(电子版)，2018，12(6): 757-761.
[12]
Sonnery-Cottet B, Archbold P, Zayni R, et al. High lateral portal for sparing the infrapatellar fat-pad during ACL Reconstruction[J]. Orthop Traumatol Surg Res, 2011, 97(8): 870-873.
[13]
Kamei G, Ochi M, Usman M, et al. A new technique to avoid articular cartilage injury in anterior cruciate ligament reconstruction through far antero-medial portal[J]. Orthop Traumatol Surg Res, 2014, 100(7): 827-830.
[14]
Bakhsh WR, Cherney SM, Mcandrew CM, et al. Surgical approaches to intramedullary nailing of the tibia: comparative analysis of knee pain and functional outcomes[J]. Injury, 2016, 47(4): 958-961.
[15]
Gelber PE, Reina F, Torres R, et al. Anatomic single-bundle anterior cruciate ligament reconstruction from the anteromedial portal：evaluation of transverse femoral fixation in a cadaveric model[J]. Arthroseopy, 2010, 26(5): 651-657.
[16]
Clockaerts S, Bastiaansen-Jenniskens YM, Runhaar J，et al. The infrapatellar fat pad should be considered as an active osteoarthritic joint tissue: a narrative review[J]. Osteoarthritis Cartilage, 2010, 18 (7): 876-882.
[17]
Bastiaansen-Jenniskens YM, Clockaerts S, Feijt C, et al. Infrapatellar fat pad of patients with end-stage osteoarthritis inhibits catabolic mediators in cartilage [J]. Ann Rheum Dis, 2012, 71(2): 288-294.
[18]
Macchi V, Porzionato A, Sarasin G, et al. The infrapatellar adipose body: a histotopographic study[J]. Cells Tissues Organs, 2016, 201(3): 220-231.
[19]
Bohnsack M, Wilharm A, Hurschler C, et al. Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee[J]. Am J Sports Med, 2004, 32(8): 1873-1880.
[20]
Kim SJ, Kim HJ. High portal: Practical philosophy for positioning portals in knee arthroscopy[J]. Arthroscopy, 2001, 17(3): 333-337.
[1] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2] 苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[3] 赵飞鸿, 陈颖杰, 林静芳, 郑晓春, 廖燕凌. 超声引导下周围神经阻滞对髋膝关节置换术后恢复的影响[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 457-468.
[4] 高小康, 张净宇, 刘金伟, 田东牧, 胡永成, 徐卫国. 连接型人工膝关节假体运动和负重模式的演变和进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 505-516.
[5] 闫泽辉, 狄靖凯, 郭子瑊, 穆昶江, 张智博, 陈帅, 王泽华, 田最, 向川. 膝关节机械感受器在半月板损伤中的功能[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 524-531.
[6] 杨滢甄, 黄子荣, 梁家敏, 黄晓芳, 胡艳, 朱伟民. 膝关节前交叉韧带重建术前康复治疗的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 538-544.
[7] 李程, 朱梁, 庞勇, 查国春, 仇尚, 孙伟, 冯硕. 侧侧缝合联合无结缝线桥技术治疗大型L型肩袖撕裂[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 301-306.
[8] 王典, 刘双赫, 曾峥. 肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.
[9] 曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[10] 冯亚飞, 唐诗添, 唐福宽, 周亮. 关节镜下mLSRS 技术及双排缝线桥技术治疗大型肩袖撕裂的疗效及预后分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 295-301.
[11] 王友健, 陶然, 陆跃, 马洪冬. 退行性中、小型肩袖撕裂两种临床治疗效果对比[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 302-308.
[12] 宋庆成, 郑占乐, 王天瑞, 王宇钏, 张凯旋, 纳静, 蔚佳昊, 杨思繁, 宋九宏, 张英泽. “人老膝不老”：膝关节健康管理的全方位探索与实践[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 321-324.
[13] 郑占乐, 王宇钏, 蔚佳昊, 宋庆成, 张凯旋, 纳静, 王天瑞, 宋九宏, 张英泽, 王娟. 保膝须“开膝”——“开膝”在膝骨关节炎中的临床应用价值[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 325-330.
[14] 王浩汀, 尚运涛, 曹光, 张延祠, 李军勇. 胫骨高位截骨联合关节镜与单髁置换治疗单间室膝关节骨性关节炎的临床疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(04): 229-236.
[15] 于晓光, 秦永辉, 李佳, 贾国兴, 李军, 赵振栓, 刘国彬. 人工单髁置换术治疗膝关节内侧间室骨关节炎合并前交叉韧带功能不良的近期疗效[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 337-342.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号