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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
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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]. 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]. 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
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