关节镜下膝关节骨性关节炎伴半月板损伤分析

目的探讨膝关节骨性关节炎（OA）伴发半月板损伤的发生率及其在诊断治疗中的意义。方法对因第一诊断为膝关节OA而行关节镜下关节清理术共120例125个膝关节,分析半月板损伤的发生率、损伤类型及其与OA严重程度的相关性,并对选择性关节腔清理结合半月板修切术的疗效进行评价。结果症状以膝关节疼痛为主,无游离体而有绞锁现象者32膝（25．6％）,术前诊断OA合并半月板损伤22膝（17．6％）,LYSHOLM评分平均52分。术中发现内侧半月板损伤41膝（32．8％）,外侧半月板损伤21膝（16．8％）,其中内外侧均损伤7膝（5．6％）。镜下损伤类型主要为磨损（29．0％）、边缘毛刷样破损（12．9％）、各种破裂（51．6％）以及桶柄样撕裂（1．61％）,损伤程度与关节软骨破坏程度明显呈正相关,手术前后诊断符合率为40．0％（22／55）。术后3、6、12个月复诊,总体满意率分别为89．6％（107／120）、86．4％（104／120）、83．2％（100／120）,有半月板损伤者满意率分别为94．5％（59／62）、91．0％（56／62）、87．3％（54／62）,平均LYSHOLM评分分别为77、74、71分和85、82、79分。结论膝关节OA往往伴有半月板损伤,两者可有相互加重的作用。部分OA患者保守治疗难以缓解膝关节症状或延缓OA的病程,关节镜下清理术有一定的诊断和治疗价值。

Meniscus injury in osteoarthritis of knee joints: under arthroscopy

Objective To study the occurrence rate of meniscus injury in osteoarthritis(OA) of knee joint and inquire into the significance of meniscus injury in diagnosis and treatment of OA.(Methods 125 knees) of 120 cases with OA as the first diagnosis were observed when debridement was done under arthroscopy.The occurrence rate of meniscus injury and the relationship between the degree of OA and meniscus injury were analyzed.The curative effect of selective joint space debridement with meniscus fitting and resection was evaluated.Results Pain was the most common symptom of this group.32 cases(25.6%) had locked knee but without loose body in the joint according to X ray.22 joints(17.6%) were diagnosed as OA accompanied by meniscus injury before operation.The average LYSHOLM score was 52.Medial and lateral meniscus injury was observed in 41 joints(32.8%) and 21 joints(16.8%) respectively, 7 of them(5.6%) had injury at both sides.The type of meniscus injury under arthroscopy mainly included wear at different parts(29.0%),brush-like damage at the edge(12.9%),different kinds of rupture(51.6%),and bucket handle tear(1.61%).There was an obvious positive correlation between the degree of meniscus injury and cartilage damage.The coincidence rate of the diagnoses before and after operation was 40.0%.The total satisfactory rate was 89.6%%,86.4%,and 83.2% and the satisfactory rate of those meniscus injury were 94.5%,91.0%,and 87.3% 3,6,and 12 months after operation.The average LYSHOLM score was 77,74,71 and 85,82,79 respectively.Conclusion A of knee joint is usually accompanied by meniscus injury,and these 2 pathologic changes aggravate each other.In some patients the symptoms and progress of OA may not be ameliorated and the progress of OA may not be postponed if only conservative treatment is adopted.