镜下膝外侧半月板治疗远期疗效分层比较△

Stratified comparison of long-term outcomes of arthroscopic treatment of lateral meniscus of the knee

摘要:

[目的] 分层分析膝关节外侧半月板损伤经膝关节镜治疗的远期疗效。[方法] 回顾性分析 2008 年 10 月—2018 年 12 月就诊于本院的 326 例 331 膝外侧半月板损伤并采用关节镜手术治疗患者的临床资料，男 202 例，女 124 例；年龄平均 （39.3±11.3）岁。探讨性别、年龄、损伤至手术时间、损伤类型、手术方式对术后远期疗效的影响。[结果]按性别分组，男性与女性间 VAS 评分、Lysholm 评分、Tegner 评分、Rasmussen 评分、膝最大屈曲 ROM、最大伸直缺失、膝关节间隙压痛的差异均无统计学意义 （P＞0.05）。按年龄分组，≤40 岁患者末次随访时 Lysholm 评分 [(88.5±1.6) vs (84.1±1.1), P＜0.001]、Tegner 评分 [(6.7±0.8) vs (5.5±0.9), P＜0.001]、Rasmussen 评分 [(27.6±1.3) vs (23.8±1.4), P＜0.001]、膝最大屈曲 ROM [(134.4±3.0)° vs (124.2± 1.8)°, P＜0.001] 均显著优于＞40 岁组，但前者 VAS 评分 [(2.1±0.5) vs (1.5±0.7), P＜0.001]、最大伸直缺失 [(1.2±0.9)° vs (0.0±0.2)°, P＜ 0.001] 明显不及后者。按损伤至手术时间分组，≤28 d 患者术前及末次随访上述评分及膝最大屈曲、最大伸直缺失均显著优于 ＞28 d 患者（P＜0.05）。按损伤程度分组，单纯损伤组术前及末次随访上述评分及膝最大屈曲、最大伸直缺失均显著优于复合损伤组 （P＜0.05）。按手术方法分组，部分切除组术前及末次随访的上述评分、膝最大屈曲、最大伸直缺失均显著优于缝合组及次全切除组（P＜0.05），部分切除组术前间隙压痛比率差显著高于缝合组及次全切除组（P＜0.05），末次随访时，三组间隙压痛比率差异无统计学意义（P＞0.05）。[结论]膝关节外侧半月板损伤采用关节镜治疗远期疗效较好，尤其对于年龄不大、病程较短、损伤类型简单的患者远期疗效良好。

Abstract:

[Objective] To analyze the long-term clinical outcomes of knee arthroscopic surgeries for lateral meniscus injury by stratification. [Methods] A retrospective study was conducted on 326 patients (331 knee) who had the lateral meniscus injury treated arthroscopi-cally in our hospital from October 2008 to December 2018, involving 202 males and 124 females with a mean age of (39.3±11.3) years. The clinical data were compared by stratification based on gender, age, injury time, injury type and operation method. [Results] In term of gender, there were no significant differences in VAS, Lysholm, Tegner and Rasmussen scores, as well as maximum knee flexion ROM, loss of maximum knee extension and knee space tenderness between male and female (P＞0.05). In term of age, the patients aged ≤40 years proved significantly superior to those aged ＞40 years in Lysholm score [(88.5±1.6) vs (84.1±1.1), P＜0.001], Tegner score [(6.7±0.8) vs (5.5±0.9), P＜ 0.001], Rasmussen score [(27.6±1.3) vs (23.8±1.4), P＜0.001], maximum knee flexion ROM [(134.4±3.0)° vs (124.2±1.8)°, P＜0.001], whereas the former was significantly inferior to the latter in VAS score [(2.1±0.5) vs (1.5±0.7), P＜0.001] and loss of maximum knee extension [(1.2±0.9)° vs (0.2±0.0)°, P＜0.001] at the latest follow-up. In term time interval from the injury to operation, patients with time ≤28 days were significantly better than those with ＞ 28 days regarding abovesaid scores and the maximal knee flexion ROM and loss of maximum knee extension before and at the last follow-up (P＜0.05). In term of injury extent, the patients with simple injury proved significantly superior to those with complex injuries in above scores, maximum knee flexion and loss of maximum knee extensions before and at the last followup (P＜0.05). In term of the surgical method, the patients received partial meniscectomy were significantly superior to those underwent meniscus suture and subtotal meniscectomy in abovementioned scores, maximum knee flexion ROM and loss of maximum knee extension before operation and at the last follow-up (P＜0.05). In addition, the patients received partial meniscectomy had significantly higher ratio of preoperative joint space tenderness than those received meniscus suture and subtotal meniscectomy (P＜0.05), although there was no a significant difference in the ratio of joint space tenderness among the three groups at the latest follow-up (P＞0.05). [Conclusion] The longterm consequence of arthroscopic treatment for lateral meniscus injury of the knee is good, especially for patients with young age, short interval from injury to surgery and simple injury type.