髌内侧滑膜皱襞综合征为主的膝关节内紊乱

目的:通过临床病例观察,探讨膝内侧滑膜皱襞综合征的诊断、类型及与半月板损伤、软骨损害的关系,分析膝内侧滑膜皱襞综合征的特点及在骨性关节炎发病中所起的作用。方法:关节镜下治疗内侧滑膜皱襞综合征患者48例(53膝),其中男13例(13膝),女35例(40膝);年龄16~71岁,平均56岁;病程1个月~10年,平均26个月。48例于关节镜直视下观察并手术切除滑膜皱襞,处理相应病变。采用Lysholm膝关节量表记分法评价疗效。观察症状体征与实际病损的关系,计算术前与术中诊断的符合率。关节镜下观察症状性滑膜皱襞的部位、性状、分型及软骨磨损的部位和分级,分析增生的滑膜皱襞与半月板损伤、软骨损害的关系。对术前后Lysholm评分采用SPSS13.0统计软件进行统计学处理。结果:常见的软骨缺损有股骨内髁内侧的沟槽状缺损及股骨内侧滑车的类圆形缺损。软骨退变以股骨内髁非负重区为主,占总数的54.29%;以股骨滑车内侧次之,占40.00%;以髌骨内侧关节面为主的缺损居第3位,占5.71%。术后48例53膝均获随访,随访时间17个月~4年,平均28个月。Lysholm膝关节评分:术前平均(41.00±7.03)分,术后平均(85.00±8.01)分(t=-26.17,P<0.001),证明关节镜治疗效果显著。本组优(>90分)12膝,良(80~90分)37膝,可(70~79分)4膝,优良率92.45%,无复发及二次手术者。结论:通过关节镜下特征性改变可以对内侧滑膜皱襞综合征做出明确诊断,股骨内髁及滑车软骨的沟槽状及类圆形磨损是2种典型的皱襞引起的软骨缺损。镜下切除滑膜皱襞疗效满意,对防止软骨进一步损害有积极的意义。

The disorders of the knee joint with symptomatic medial patellar plica syndrome

Objective:To discuss the pathogenesis of symptomatic medial patellar plica(MPP)syndrome and the relationship between MPP and meniscus injury or chondropathy and analyze the features of MPP and its role in the development of osteoarthritis.Methods:Arthroscopy was performed on 53 medial patellar plica(48 patients) by a single arthroscopic surgeon between September 2002 and July 2005,there were 13 male(13 knees) and 35 female(40 knees) in this group,the average age was 56 years,duration of disease varied from 1 month to 10 years(average 26 months),and all plica were excised.The pre-and post-operative knee joint functions were assessed with Lysholm knee joint function score.The relationship between the clinicl symptoms and impairment were analyzed,then the diagnostic accordance was calculated.The position,characters,type of symptomatic synovial plica and position,grading of chondromalacia were observed by arthroscopy respectively.The relationship between MPP and meniscus injury or chondropathy was also analyzed.Statistics work was done with SPSS 13.0 statistical software.Results: The femoral groove-type chondropathy and round-like chondropathy were two common types of articular cartilage defect.The cartilage dgeneration of medial femoral condyle in unweight loading area was 54.29%,medial femoral trochlea was 40.00% and the medial side of articular surface of patella was 5.71%.All patients were followed up for an average time of 28 months(from 17 months to 4 years).The score of Lysholm was raised from(41.00±7.03) to(85.00±8.01),and no case had recrudesced.Conclusion:The clinical features of symptomatic MPP syndrome are nonspecific,but it can be easily diagnosed by arthroscopy.Medial patellar plica plays a mechanical role in the development of medial femoral chondropathy,excision of plica is confirmed to be a prophylactic procedure to the cartilage damage.