中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (11): 2052-2055.doi: 10.3969/j.issn.1673-8225.2010.11.038

• 组织构建学术探讨 tissue construction academic discussion • 上一篇    下一篇

盘状半月板与正常半月板的损伤：关节镜下分型及组织修复

黄媛霞，段永壮，徐海斌   

  1. 新乡医学院第一附属医院骨科，河南省卫辉市453100
  • 出版日期:2010-03-12 发布日期:2010-03-12
  • 作者简介:黄媛霞，女，1975年生，河南省项城市人，汉族，2002年宁夏医学院毕业，硕士，主治医师，主要从事骨关节及脊柱相关疾病的研究。 zhoudiange@medmail.com.cn hyx@xxmu.edu.cn

Normal meniscus and discoid meniscus injuries: Classification and tissue repair under an arthroscopy

Huang Yuan-xia, Duan Yong-zhuang, Xu Hai-bin   

  1. Department of Orthopaedics, First Affiliated Hospital of Xinxiang Medical College, Weihui  453100, Henan Province, China
  • Online:2010-03-12 Published:2010-03-12
  • About author:Huang Yuan-xia, Master, Attending physician, Department of Orthopaedics, First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan Province, China zhoudiange@medmail.com.cn or hyx@xxmu.edu.cn

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摘要：

背景：目前对盘状半月板及正常半月板损伤的治疗，多主张行关节镜下半月板成形术或修复术，切除内侧撕裂部分，缝合外侧撕裂部分，保留正常形态。
目的：对盘状半月板及正常半月板损伤行关节镜修复治疗，并镜下观察两者损伤后的分型特点，采取对应的手术方式，分析对比修复后效果。
方法：选择2003-09/2008-06新乡医学院一附属医院收治的260例半月板损伤患者，其中45例盘状半月板均为外侧盘状半月板，215例为正常形态半月板损伤。所有患者均于镜下明确诊断并按期随访。采用关节镜下探查盘状半月板及正常半月板损伤的情况，记录撕裂部位及分型，根据不同损伤情况行半月板成形术、部分切除术、次全切除术或者全切除术。
结果与结论：所有患者随访半年至2年，按Tegner膝关节功能评分评价关节功能。盘状半月板水平裂占73.3%，复杂撕裂15.5%，放射性撕裂4.4%，纵裂2.2%；正常半月板纵裂47.9%，放射性撕裂28.8%，水平裂11.6%，横裂6.5%，复杂撕裂5.1%。215例正常半月板损伤患者中显效165例，有效35例，尚可8例，无效7例，优良率为93.0%。45例盘状半月板损伤患者显效25例，有效16例，尚可3例，无效1例，优良率为91.1%。结果提示，盘状半月板因其解剖学特征和组织学特性与正常形态半月板不同，其损伤类型和治疗方法也有区别；治疗时应最大程度的保留半月板功能，延缓关节退变，除严重撕裂无法保留者，尽量行半月板成形术。

关键词: 半月板, 盘状半月板, 关节镜, 半月板成形术, 软骨组织工程

Abstract:

BACKGROUND: Meniscus plasty and prosthesis under an arthroscopy are widely used in treating discoid meniscus or normal meniscus injury. The normal shapes of meniscus are maintained by excising medial partial tears and suturing the lateral partial tears.
OBJECTIVE: Injury classification and special features of discoid meniscus and normal meniscus were observed, and corresponding treating methods were used, to discuss the therapeutic effect of repair. 
METHODS: Totally 260 cases of meniscus injury in knee joint were selected from the First Affiliated Hospital of Xinxiang Medical University from September 2003 to June 2008. They were divided into normal meniscus injury group (n=215), and discoid lateral meniscus injury (n=45). People with complete clinical data before operation and following data, confirmed by arthroscopy were selected. Meniscus injury in 260 cases was examined by arthroscopy, and plasty, or partial excision or incomplete resection or full resection was performed according to the injury types and surgical circumstance.
RESULTS AND CONCLUSION: All subjects were followed for half a year to 2 years. The knee function was evaluated by the Tenger criterion. Four tear types of Discoid meniscus were as follows: 73.3% horizontal, 15.5% complex, 4.4% radial, and 2.2% longitudinal. Five tear types of normal meniscus were as follows: 47.9% longitudinal, 28.8% radial, 11.6% horizontal, 6.5% transverse and 5.1% complex. In 215 cases of normal meniscus, there were 165 knees with excellent function, 35 with good, 8 with fair and 7 with poor. The excellent and good rate was 93.0%. In 45 cases of discoid meniscus, there were 25 knees with excellent function, 16 with good, 3 with fair and 1 with poor. The excellent and good rate was 91.1%. Discoid meniscus is different from normal meniscus in anatomical feature and histological structure, therefore, the arthroscopic surgery for discoid meniscus is also different. The most function of meniscus should be remained and the degeneration of knee joint should be delayed. Meniscus plasty should be performed in all discoid meniscuses except the patients with severe tear of meniscus.

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