麦氏征在判断骨关节病患者关节镜半月板切除术疗效中的作用

发布时间：2019-05-18 17:00

【摘要】：背景与目的目前使用关节镜外科手术治疗伴有骨关节病的半月板损伤存在争议,主要由于其术后疗效难以评估。近年来,关于关节镜下半月板切除术在骨关节病患者中应用的争论主要聚焦于手术患者的病例选择,支持关节镜手术的学者认为具有“有症状的半月板损伤”的患者需要手术干预,对于这些骨关节病患者来说,切除不稳定的损伤的半月板是有必要的。然而,如何精确定义“有症状的半月板损伤”是非常困难的,尤其是在患有骨关节病的患者中,因此,术前准确诊断“有症状的半月板损伤”可能是解决此类问题的关键所在。由于麦氏征是反应膝关节半月板损伤的重要体征之一,尤其是不稳定的半月板损伤,因此我们假设麦氏征不仅可以精确的在术前判断是否为“有症状的半月板损伤”,同时也能以此来评估手术以后的疗效。本研究通过对比骨关节病患者的麦氏征与关节镜检查结果,分析麦氏征的敏感度及特异度,以及观察麦氏征检查结果与患者术后预后之间的关系,以此来判断骨关节病的患者中,那些患者需要进行关节镜下半月板切除手术。方法回顾性分析本院2008年3月至2011年8月期间,149例由影像学诊断为“半月板损伤伴骨关节病”并经过关节镜手术治疗的患者(平均年龄58.8岁),术后平均随访12个月。根据麦氏征结果与关节镜检查是否存在半月板损伤符合程度计算麦氏征的敏感度及特意度。根据其术前麦氏征结果进行分组,对比组间手术前后患者Lysholm评分及VAS评分改善程度。结果麦氏征的敏感度及特异度分别为79.27%与67.16%,麦氏征阳性且关节镜检查存在半月板损伤的患者Lysholm评分由术前平均43.25分改善为术后平均75.82分(P0.05), VAS评分则由术前平均7.91分改善至术后平均3.07分(P0.05),并与其他组间对照,差异存在统计学意义(P0.05)。结论在合并骨关节病的半月板损伤患者中,麦氏征阳性可以作为预计术后疗效满意的依据。在膝关节骨关节病的治疗中,麦氏征阳性,并于影像学资料相符的患者需要进行手术治疗。
[Abstract]:Background & objective at present, the use of arthroscopy in the treatment of meniscus injury with osteoarthropathy is controversial, mainly because it is difficult to evaluate the postoperative efficacy. In recent years, the debate about the application of arthroscopic meniscus resection in patients with osteoarthropathy has mainly focused on the choice of cases in patients undergoing surgery. Scholars who support arthroscopic surgery believe that patients with "symptomatic meniscus injury" need surgical intervention. For these patients with osteoarthropathy, it is necessary to remove unstable meniscus. However, it is very difficult to accurately define "symptomatic meniscus injury", especially in patients with osteoarthropathy. Therefore, accurate preoperative diagnosis of "symptomatic meniscus injury" may be the key to solve this problem. Because McCartney's sign is one of the important signs of meniscus injury of knee joint, especially unstable meniscus injury, we assume that McCartney's sign can not only accurately judge whether it is "symptomatic meniscus injury" before operation. At the same time, it can also be used to evaluate the curative effect after operation. In this study, the sensitivity and specificity of McDonalski sign were analyzed by comparing the results of McChrystal sign and arthroscopy in patients with osteoarthropathy, and the relationship between the results of McChrill sign and the prognosis of patients was observed. In order to judge the patients with osteoarthropathy, those patients need arthroscopic meniscus resection. Methods from March 2008 to August 2011, 149 patients (mean age 58.8 years) diagnosed as meniscus injury with osteoarthropathy and treated by arthroscopy were analyzed retrospectively. The average follow-up period was 12 months. The sensitivity and specificity of Macs sign were calculated according to the coincidence degree of meniscus injury between the results of McDonalski sign and arthroscopy. The Lysholm score and VAS score of the patients before and after operation were compared according to the results of McDonalski sign before and after operation. Results the sensitivity and specificity of McGrady's sign were 79.27% and 67.16%, respectively. The Lysholm score of patients with positive McDonalski sign and meniscus injury was improved from an average of 43.25 points before operation to an average of 75.82 points after operation (P 0.05). The VAS score improved from 7.91 points before operation to 3.07 points after operation (P 0.05), and there was significant difference between the two groups (P 0.05). Conclusion in patients with meniscus injury complicated with osteoarthropathy, the positive sign can be used as the basis for predicting the satisfactory curative effect after operation. In the treatment of osteoarthropathy of knee joint, patients with McGrady's sign positive and consistent with imaging data need surgical treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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