组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (4): 374-.

• • 上一篇    下一篇

不同半月板损伤类型对关节镜手术时机及疗效的影响研究

  

  • 出版日期:2025-08-01 发布日期:2025-09-08

Research on the impact of different types of meniscus injuries on the timing and efficacy of arthroscopic surgery in patients

  • Online:2025-08-01 Published:2025-09-08

摘要:

 目的 探索不同半月板损伤类型对关节镜手术时机及疗效的影响。方法 回顾性选取2022年3月至2024年3月本院收治的不同半月板损伤类型患者160例,根据半月板损伤类型不同以及受伤至接受手术的时间,分为水平裂+早期组(A组)、水平裂+晚期组(B组);纵行撕裂+早期组(C组)、纵行撕裂+晚期组(D组);放射状撕裂+早期组(E组)、放射状撕裂+晚期组(F组);盘状撕裂组+早期组(G组)、盘状撕裂组+晚期组(H组);混合撕裂组+早期组(I组)、混合撕裂组+晚期组(J组),每组各16例。对比各组在术前与术后多个时间点(即术后当日、术后1个月、术后3个月、6个月、9个月)的国际膝关节文献委员会膝关节评分(IKDC)、Lysholm膝关节(Lysholm)评分、视觉模拟评分(VAS)、炎症因子水平变化、膝关节活动度(ROM)、膝关节功能优良率以及术后并发症的发生率。运用双重差分(DID)模型对不同关节镜手术时机的疗效进行评价。结果 术后1、3、6、9个月的IKDC、Lyscholm评分均较术前逐渐提高,早期组均高于晚期组,且 C、D两组高于同时间其他组评分(P<0.05);术后 1、3、6、9个月的 VAS评分较术前逐渐降低;早期组均高于晚期组,且C、D两组低于同时间其他组值(P<0.05);术后1、3、6、9个月的ROM均较术前逐渐提高,早期组ROM高于晚期组(P<0.05);术后1、3、6、9个月的炎症因子白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)浓度水平均较术前逐渐降低,早期组均低于晚期组,且C、D两组低于同时间其他组(P<0.05);早期组的膝关节功能总优良率高于晚期组(P<0.05),C组总优良率最高(93.75%),B组总优良率最低(62.50%);早期组术后并发症发生率低于晚期组(P<0.05),C组并发率最低(6.25%),B 组并发率最高(31.25%);DID 结果显示,早期组对 IKDC(β=1.869,P<0.001)和 Lyscholm(β=3.216,P<0.001)的评分改善优于晚期组,对 VAS(β=-1.248,P<0.001)的评分改善低于晚期组。结论 早期组 IKDC、Lyscholm评分优于晚期组,早期组VAS评分差于晚期组;纵行撕裂伤术后指标均优于其他损伤类型,故不同半月板损伤类型对患者关节镜手术时机及疗效存在一定的影响。

关键词:

Abstract:

Objective To explore the impact of varying meniscal injury types on the optimal timing and effectiveness of
arthroscopic surgical intervention. Methods A retrospective analysis was conducted on 160 patients with varying types of
meniscal injuries, who were admitted to our hospital between March 2022 and March 2024. These patients were stratified into
ten distinct groups, with 16 patients in each, based on the nature of their meniscal injury (horizontal fissure, longitudinal
tear, radial tear, discoid tear, mixed tear) and the elapsed time from injury to surgical intervention (early vs. late).
Specifically, the groups were labeled as follows: A (horizontal fissure-early), B (horizontal fissure-late), C (longitudinal tear-early), D (longitudinal tear-late), E (radial tear-early), F (radial tear-late), G (discoid tear-early), H (discoid tear-late), I (mixed tear-early), and J (mixed tear-late). The study compared key outcome metrics across multiple preand post-operative time points (postoperative day,1 month,3 months,6 months, and 9 months), including the International Knee Documentation Committee (IKDC) score, Lysholm knee score, visual analog scale (VAS) pain intensity,inflammatory biomarker fluctuations, knee range of motion (ROM), the proportion of excellent knee function outcomes, and the frequency of postoperative complications. To assess the effectiveness of arthroscopic surgery timing, a difference-indifferences (DID) analytical approach was employed. Results The postoperative evaluations at 1,3,6, and 9 months revealed a steady enhancement in IKDC and Lysholm scores, surpassing preoperative baselines (P<0.05). Notably, the early surgical intervention cohort demonstrated superior outcomes compared to the late group, with groups C and D particularly outperforming their contemporaneous counterparts (P<0.05). Regarding pain intensity, as measured by the VAS, there was a consistent reduction from preoperative levels (P<0.05). Again, the early group reported lower pain scores than the late group, and Groups C and D exhibited the mast notable decrease among all groups simultaneously (P<0.05). The knee range of motion (ROM) progressively increased from preoperative to postoperative assessments at 1,3,6, and 9 months (P< 0.05), with the early group displaying greater gains than the late group (P<0.05). Additionally, inflammatory markers like interleukin-1β(IL-1β) and tumor necrosis factor alpha (TNF- α) exhibited a gradual decline post-surgery compared to preoperative levels (P<0.05), with the early group and groups C and D demonstrating the most significant reductions (P<0.05). In terms of knee function, the early group had a higher overall excellent and good rate compared to the late group (P<0.05). Notably, group C achieved the highest rate of 93.75%, while group B had the lowest at 62.50%. Furthermore, the incidence of postoperative complications was lower in the early group (P<0.05), with group C exhibiting the lowest rate of 6.25% and group B the highest at 31.25%. The difference-in-differences (DID) analysis underscored the benefits of early surgery, with the early group demonstrating a more pronounced improvement in IKDC (β=1.869,P<0.001) and Lysholm (β= 3.216,P<0.001) scores, as well as a more substantial reduction in VAS scores (β=-1.248,P<0.001) compared to the late group. Conclusion The early surgical intervention cohort demonstrated superior IKDC and Lysholm scores in comparison to the late group, whereas the VAS scores were less favorable in the early group as opposed to the late group. Additionally, the
postoperative outcomes pertaining to longitudinal meniscal tears exhibit enhanced performance about alternative injury types,highlighting the influence that distinct meniscus injury classifications exert on the optimal timing and effectiveness of
arthroscopic surgical interventions for patients.

Key words: