NON-OPERATIVE TREATMENT OF MENISCAL TEARS
NON-OPERATIVE TREATMENT OF MENISCAL TEARS
复制标题
DOI：
10.2106/00004623-198971060-00003
复制
发表时间：
1989-07-01
影响因子：
5.3
通讯作者：
GILLQUIST, J
中科院分区：
文献类型：
--
作者：
WEISS, CB;LUNDBERG, M;GILLQUIST, J
回顾性分析了3,612例关节镜手术治疗急性或慢性踝关节病变（伴或不伴相关韧带病变）的结果，我们发现80例踝关节撕裂（75例患者）被认为是稳定的。70例为垂直纵向撕裂，10例为垂直径向撕裂。70处纵向撕裂包括52处外侧病变和18处内侧病变。所有径向撕裂均位于外侧半月板。在75名患者中，52名患者接受了2至10年的随访。在随访时，这52例患者中只有6例因与尿道撕裂相关的症状需要额外干预。其中4人在与运动有关的创伤性稳定撕裂扩展后进行了干预，2人是因为最初的尿道损伤引起了持续的症状。在初次关节镜检查后平均26个月，对32例患者（其中26例纵向撕裂，6例径向撕裂）进行了重复关节镜检查。26处纵向撕裂中有17处完全愈合。6例桡动脉撕裂中有5例没有愈合迹象，1例已延长。韧带松弛或在发现时为慢性的椎间盘撕裂似乎都不会妨碍稳定纵向撕裂的愈合。邻近关节软骨中没有发现与任何稳定的垂直纵向或径向关节病变相关的局部退行性变化。排除6名接受额外手术治疗的患者，填写问卷的52名患者中没有一名报告他们有尿道病变的症状，并且在手术后两年或更长时间复查的42名患者中没有一名有尿道病变的迹象。稳定的垂直纵向撕裂，往往发生在周围血管部分的髂胫束，有很大的愈合潜力。撕裂应单独放置，除非它是发现的唯一异常，并且引起需要治疗的症状。稳定的径向撕裂，往往发生在半月板无血管的内三分之一，几乎没有愈合的潜力。本研究未确定最好是保留这些损伤，还是通过修整半月板来形成完整的边缘。
In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which ten to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.