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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。
Objective To investigate the clinical effect of arthroscopic central resection and peripheral suture in the treatment of children with discoid lateral meniscus (DLM) injury. Methods Sixty-nine patients (87 knees) with DLM injury were retrospectively analyzed. Among them, 27 (31 knees) were classified into meniscocapsular junction anterior horn type (MC) according to diagnostic arthroscopy -A), posterior meniscus junction posterior horn type (MC-P) and posterior lateral posterolateral corner (PLC) type III, and MC-A type Central part resection plus extroverted suture technique, MC-P and PLC type central part resection plus internal or external suture technique, 25 cases (27 knees) were followed up for 24 to 92 months with an average of 52.6 months. In this group, 2 patients (2 knees) under 6 years of age with an average body weight of 17.5 kg; 12 children (7 knees) aged 7 to 12 years, with an average body weight of 35.8 kg; 11 patients (12 knees) aged 12 to 14, Average body weight 42.2 kg. Preoperative and postoperative Lynsholm knee scores were compared. Results The main clinical manifestations of all children with 27-DL DLM injuries were limited knee extension, snapping and bouncing sensations, mechanical twist and tenderness of the joint line. Diagnosed by diagnostic arthroscopy in the classification of MC-A type in 7 cases, MC-P type in 9 cases, PLC type in 11 cases. All patients had limited knee extensor, joint snapping and bouncing sensation, mechanical twist and joint line tenderness disappeared. The average Lysholm score was 62.82 points (71.8 points preoperatively) and 90-100 points 97.1 points (P <0.0001). Conclusion The children with discoid meniscus injury combined with peripheral tearing using the central part of the shape combined with total internal suture, external and internal suture repair, access to satisfactory healing and maximum meniscal preservation to avoid total meniscal cutting Long-term complications.