两种关节镜手术入路治疗外侧盘状半月板损伤的比较

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。

Comparison of two arthroscopic operative portals for lateral discoid meniscus injuries

ObjectiveTo 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. MethodsSixty-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. ResultsAll 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) . ConclusionsBoth 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.