CAJ | 학술논문

目的探讨内侧半月板退变性损伤的关节镜下分型及其临床意义.方法 2012年1至12月因内侧半月板退变性损伤接受关节镜手术者122例,不包括因重度滑膜炎需做滑膜切除者.男27例,女95例；年龄37～80岁,平均(61.8±8.9)岁.左膝63例,右膝59例.BMI平均(26.5±3.4)kg/m2,术前Lysholm评分(47.2±15.0)分.关节镜术中依据Outerbridge软骨损伤分级对软骨损伤进行评估,比较不同分型者(后角水平撕裂、后角根部损伤和复杂严重损伤)Ⅳ度软骨退变性损伤所累及的关节面数量及术前Lysholm评分.结果后角水平撕裂33例,Ⅳ度软骨退变性损伤累及的关节面(1.24±1.48)个,术前Lysholm评分(52.5±14.4)分,其中疼痛评分(7.7±6.5)分；后角根部损伤16例,Ⅳ度软骨退变性损伤累及的关节面(1.13±1.26)个,术前Lysholm评分(37.5±8.4)分,其中疼痛评分(3.1±4.0)分；复杂严重损伤73例,Ⅳ度软骨退变性损伤累及的关节面平均(2.26±1.61)个,术前Lysholm评分平均(46.9±15.3)分,其中疼痛评分(6.8±5.4)分.后角根部损伤者术前Lysholm评分低于后角水平撕裂和复杂严重损伤者,差异有统计学意义；其中疼痛评分的差异也有统计学意义.后角根部损伤者Ⅳ度软骨退变性损伤累及的关节面数量与后角水平撕裂者的差异无统计学意义；均小于复杂严重损伤者,差异有统计学意义.结论关节镜下内侧半月板退变性损伤可分为三种类型.后角根部损伤和后角水平撕裂的软骨退变性损伤相对较轻,是较早期的关节退变；其中后角根部损伤的临床症状和功能减退较为明显.复杂严重损伤的软骨退变性损伤相对较重,是较晚期的关节退变,但临床症状和功能减退却相对较轻.
목적 탐토내측반월판퇴변성손상적관절경하분형급기림상의의.방법 2012년1지12월인내측반월판퇴변성손상접수관절경수술자122례,불포괄인중도활막염수주활막절제자.남27례,녀95례；년령37～80세,평균(61.8±8.9)세.좌슬63례,우슬59례.BMI평균(26.5±3.4)kg/m2,술전Lysholm평분(47.2±15.0)분.관절경술중의거Outerbridge연골손상분급대연골손상진행평고,비교불동분형자(후각수평시렬、후각근부손상화복잡엄중손상)Ⅳ도연골퇴변성손상소루급적관절면수량급술전Lysholm평분.결과 후각수평시렬33례,Ⅳ도연골퇴변성손상루급적관절면(1.24±1.48)개,술전Lysholm평분(52.5±14.4)분,기중동통평분(7.7±6.5)분；후각근부손상16례,Ⅳ도연골퇴변성손상루급적관절면(1.13±1.26)개,술전Lysholm평분(37.5±8.4)분,기중동통평분(3.1±4.0)분；복잡엄중손상73례,Ⅳ도연골퇴변성손상루급적관절면평균(2.26±1.61)개,술전Lysholm평분평균(46.9±15.3)분,기중동통평분(6.8±5.4)분.후각근부손상자술전Lysholm평분저우후각수평시렬화복잡엄중손상자,차이유통계학의의；기중동통평분적차이야유통계학의의.후각근부손상자Ⅳ도연골퇴변성손상루급적관절면수량여후각수평시렬자적차이무통계학의의；균소우복잡엄중손상자,차이유통계학의의.결론 관절경하내측반월판퇴변성손상가분위삼충류형.후각근부손상화후각수평시렬적연골퇴변성손상상대교경,시교조기적관절퇴변；기중후각근부손상적림상증상화공능감퇴교위명현.복잡엄중손상적연골퇴변성손상상대교중,시교만기적관절퇴변,단림상증상화공능감퇴각상대교경.
Objective To explore the classification of degenerative medial meniscus injury under arthroscopy and its clinical significance.Methods This study involved 122 patients who underwent arthroscopic operation because of degenerative medial meniscus injury from January 2012 to December 2012,eliminating patients who received synovectomy for severe synovitis.There were 27 males and 95 females,with 63 left knees and 59 right knees.The average age was 61.8±8.9 years.The average BMI was 26.5±3.4 kg/m2,while the average preoperative Lysholm score was 47.2± 15.0.The cartilage injury was estimated by Outerbridge classification system during arthroscopic surgery.Both the difference of the preoperative Lysholm score and the number of articular surfaces with Ⅳ degree of cartilage injury were compared among different types of degenerative medial meniscus injury.Resuits The horizon tear of posterior horn group included 33 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 1.24± 1.48 while the average preoperative Lysholm score was 52.5± 14.4 points,with pain score of 7.7±6.5.The root injury of posterior horn group included 16 patients,whose average number of articular surfaces with 1Ⅳ degree of cartilage injury was 1.13±1.26 and average preoperative Lysholm score was 37.5±8.4 points,with pain score of 3.1±4.0.The complex serious injury group included 73 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 2.26±1.61 and the average preoperative Lysholm score was 46.9±15.3 points,with pain score of 6.8±5.4.Both the preoperative Lysholm score and pain score of the root injury of posterior horn group was significantly lower than that of the horizon tear and the complex serious injury group.The average number of articular surfaces with Ⅳ degree of cartilage injury between the root injury and the horizon tear of posterior horn group had no significant difference.The number of these two groups was less than the complex serious injury group,with statistically significant difference.Conclusion The arthroscopic classification of degenerative medial meniscus injury could be classified into three types.The degenerative cartilage injury of root injury of posterior horn and horizon tear of posterior horn is relatively mild,which are the early stages of joint degeneration.However,the clinical symptoms and disability caused by root injury of posterior horn are more severe.On the other hand,the degenerative cartilage injury of complex serious injury is relatively severe,which belongs to the late stage,while the clinical symptoms and disability are relatively mild.