CAJ | 학술논문

目的：探讨关节镜下中央部切除加外周缝合技术的治疗儿童外侧盘状半月板( discoid lateral meniscus，DLM )损伤的临床疗效。方法回顾性分析69例(87膝) DLM 损伤手术患者，其中27例(31膝)根据诊断性关节镜检查结果分为前角半月板关节囊结合部撕裂型( meniscocapsular junction anterior horn type， MC-A )、后角半月板关节囊结合部撕裂型( meniscocapsular junction posterior horn type，MC-P )和后外侧体部纵形撕裂型( posterolateral corner，PLC )三型，MC-A 型采用中央部切除加外向内缝合技术，MC-P 和 PLC 型则采用中央部切除加内向外技术或全内缝合技术，术后25例(27膝)随访24～92个月，平均52.6个月。本组6岁以下患儿2例(2膝)，平均体重17.5 kg；7～12岁患儿12例(13膝)，平均体重35.8 kg；12～14岁患儿11例(12膝)，平均体重42.2 kg。比较术前、术后的 Lynsholm 膝关节评分。结果所有27膝 DLM 损伤患儿的主要临床表现为伸膝受限、关节弹响和弹跳感、机械性绞锁以及关节线压痛。经诊断性关节镜检查确诊分型 MC-A 型7例、MC-P 型9例、PLC 型11例。术后所有患者伸膝受限、关节弹响和弹跳感、机械性绞锁以及关节线压痛均消失，平均 Lysholm 评分：术前62～82分，平均71.8分，术后90～100分，平均97.1分(P＜0.0001)。结论儿童盘状半月板损伤合并周围部撕裂采用中央部位部分成形结合全内缝合、内向外和外向内缝合修补，可获得满意的愈合和最大程度的半月板保存，避免半月板全切导致的远期并发症。
목적：탐토관절경하중앙부절제가외주봉합기술적치료인동외측반상반월판( discoid lateral meniscus，DLM )손상적림상료효。방법회고성분석69례(87슬) DLM 손상수술환자，기중27례(31슬)근거진단성관절경검사결과분위전각반월판관절낭결합부시렬형( meniscocapsular junction anterior horn type， MC-A )、후각반월판관절낭결합부시렬형( meniscocapsular junction posterior horn type，MC-P )화후외측체부종형시렬형( posterolateral corner，PLC )삼형，MC-A 형채용중앙부절제가외향내봉합기술，MC-P 화 PLC 형칙채용중앙부절제가내향외기술혹전내봉합기술，술후25례(27슬)수방24～92개월，평균52.6개월。본조6세이하환인2례(2슬)，평균체중17.5 kg；7～12세환인12례(13슬)，평균체중35.8 kg；12～14세환인11례(12슬)，평균체중42.2 kg。비교술전、술후적 Lynsholm 슬관절평분。결과소유27슬 DLM 손상환인적주요림상표현위신슬수한、관절탄향화탄도감、궤계성교쇄이급관절선압통。경진단성관절경검사학진분형 MC-A 형7례、MC-P 형9례、PLC 형11례。술후소유환자신슬수한、관절탄향화탄도감、궤계성교쇄이급관절선압통균소실，평균 Lysholm 평분：술전62～82분，평균71.8분，술후90～100분，평균97.1분(P＜0.0001)。결론인동반상반월판손상합병주위부시렬채용중앙부위부분성형결합전내봉합、내향외화외향내봉합수보，가획득만의적유합화최대정도적반월판보존，피면반월판전절도치적원기병발증。
Objective To evaluate the clinical outcomes of surgical treatment of discoid lateral meniscal tears in children by arthroscopic central meniscectomy and peripheral suture.Methods A retrospective analysis was performed on 69 patients ( 87 knees ) with discoid lateral meniscal tears who were treated by arthroscopic surgery. According to diagnostic arthroscopic examination results, 27 patients ( 31 knees ) were classiifed as meniscocapsular junction anterior horn ( MC-A ) type, meniscocapsular junction posterior horn ( MC-P ) type and posterolateral corner ( PLC ) type. After central meniscectomy, the peripheral tears were repaired by outside-in technique in MC-A type and inside-out or all-inside technique in MC-P type and PLC type. Twenty-ifve patients ( 27 knees ) were followed up for an average period of 52.6 months ( range: 24-92 months ). Among the 25 patients, there were 2 patients ( 2 knees ) under 6 years old with the average body weight of 17.5 kg, 12 patients ( 13 knees ) between 7 to 12 years old with the average body weight of 35.8 kg, and 11 patients ( 12 knees ) between 12 to 14 years old with the average body weight of 42.2 kg. The preoperative and postoperative Lysholm scores were compared.Results All the patients complained of preoperative extension block, joint clicking and bouncing, mechanical locking and joint line tenderness, which disappeared completely after the operation. Based on the diagnostic arthroscopic examination, there were 7 cases of MC-A type, 9 cases of MC-P type and 11 cases of PLC type. The mean Lysholm score was increased from 71.8 ( range: 62-82 ) preoperatively to 97.1 ( range: 90-100 ) postoperatively (P<0.0001 ).Conclusions Satisfactory clinical outcomes can be achieved in the children with discoid lateral meniscal tears with the treatment of arthroscopic central meniscectomy and peripheral suture by outside-in, inside-out and all-inside technique, and the injured menisci can be saved as much as possible. The long-term complications of total meniscectomy can also be avoided.