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膝关节半月板损伤

Authors
Dennis A Cardone, DO
Bret C Jacobs, DO, MA
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
付维力, 主治医师

引言

膝关节半月板损伤较常见。半月板急性撕裂最常发生于膝关节扭伤；慢性退变型撕裂则见于年龄较大的患者，可在有极轻微的扭转或应力时发生。半月板撕裂可分为部分或混合撕裂；前部、侧部或后部损伤撕裂；创伤型或退变型撕裂；以及水平型、垂直型、放射型、“鹦鹉嘴样”或“桶柄样”撕裂[1]。

未经处理的、大的混合型撕裂会损害膝关节的平滑运动，导致关节积液，并可能引起骨关节炎(osteoarthritis, OA)过早发生。半月板损伤可单独发生或伴发于侧副韧带或交叉韧带撕裂。(参见“膝关节内侧副韧带损伤”和“前交叉韧带损伤”)

半月板损伤的诊断和治疗将总结在此。成人无明显特征的膝痛、膝关节体格检查和膝关节的其他特定损伤将单独讨论。(参见“成人膝关节痛的一般评估”)

解剖结构

包含在膝关节内的两个半月板为新月形的纤维软骨垫，位于股骨髁和胫骨平台之间(图 1和图 2)[2]。半月板有助于分散膝关节载荷力、旋转过程中稳定膝关节和润滑膝关节。

膝关节横截面可见：内侧和外侧半月板呈楔形，沿关节外周较厚，在外周附着于膝关节囊(此处有时被称为半月板根部附着点)。内侧半月板紧密附着于内侧副韧带，而外侧半月板并没有牢牢附着于外侧副韧带，因此外侧半月板活动度相对较大，这可能促使外侧半月板的损伤率更低。

                      

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-16.
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References
Top
  1. Binfield PM, Maffulli N, King JB. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury 1993; 24:557.
  2. Anderson BC. Office Orthopedics for Primary Care: Diagnosis and Treatment, 2nd ed, WB Saunders, Philadelphia 1999.
  3. Smith BW, Green GA. Acute knee injuries: Part I. History and physical examination. Am Fam Physician 1995; 51:615.
  4. Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med 2003; 139:575.
  5. Frobell R, Cooper R, Morris H, Arendt E. Acute knee injuries. In: Clinical Sports Medicine, 4th ed, Brukner P, Khan K (Eds), McGraw-Hill, 2012. p.634.
  6. Francavilla ML, Restrepo R, Zamora KW, et al. Meniscal pathology in children: differences and similarities with the adult meniscus. Pediatr Radiol 2014; 44:910.
  7. Scholten RJ, Devillé WL, Opstelten W, et al. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract 2001; 50:938.
  8. Konan S, Rayan F, Haddad FS. Do physical diagnostic tests accurately detect meniscal tears? Knee Surg Sports Traumatol Arthrosc 2009; 17:806.
  9. Dzoleva-Tolevska R, Poposka A, Samardziski M, Georgieva D. Comparative analysis of diagnostic methods in meniscal lesions. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2013; 34:79.
  10. Yan R, Wang H, Yang Z, et al. Predicted probability of meniscus tears: comparing history and physical examination with MRI. Swiss Med Wkly 2011; 141:w13314.
  11. Hoppenfeld S. Physical examination of the knee. In: Physical examination of the spine and extremities, Prentice Hall, Upper Saddle River 1976. p.171.
  12. Karachalios T, Hantes M, Zibis AH, et al. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am 2005; 87:955.
  13. Harrison BK, Abell BE, Gibson TW. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Clin J Sport Med 2009; 19:9.
  14. Solomon DH, Simel DL, Bates DW, et al. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA 2001; 286:1610.
  15. Ockert B, Haasters F, Polzer H, et al. [Value of the clinical examination in suspected meniscal injuries. A meta-analysis]. Unfallchirurg 2010; 113:293.
  16. Lee SY, Jee WH, Kim JM. Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol 2008; 191:81.
  17. Bomberg BC, McGinty JB. Acute hemarthrosis of the knee: indications for diagnostic arthroscopy. Arthroscopy 1990; 6:221.
  18. Maffulli N, Binfield PM, King JB, Good CJ. Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases. J Bone Joint Surg Br 1993; 75:945.
  19. Shetty AA, Tindall AJ, James KD, et al. Accuracy of hand-held ultrasound scanning in detecting meniscal tears. J Bone Joint Surg Br 2008; 90:1045.
  20. Park GY, Kim JM, Lee SM, Lee MY. The value of ultrasonography in the detection of meniscal tears diagnosed by magnetic resonance imaging. Am J Phys Med Rehabil 2008; 87:14.
  21. Shanbhogue AK, Sandhu MS, Singh P, et al. Real time spatial compound ultrasound in the evaluation of meniscal injuries: a comparison study with conventional ultrasound and MRI. Knee 2009; 16:191.
  22. Wareluk P, Szopinski KT. Value of modern sonography in the assessment of meniscal lesions. Eur J Radiol 2012; 81:2366.
  23. Cook JL, Cook CR, Stannard JP, et al. MRI versus ultrasonography to assess meniscal abnormalities in acute knees. J Knee Surg 2014; 27:319.
  24. Alizadeh A, Babaei Jandaghi A, Keshavarz Zirak A, et al. Knee sonography as a diagnostic test for medial meniscal tears in young patients. Eur J Orthop Surg Traumatol 2013; 23:927.
  25. Brimmo OA, Smith PA, Cook CR, et al. Sonographic diagnosis of an acute lateral meniscus tear in a division I collegiate American football player. J Knee Surg Rep 2015; 1:57.
  26. Gray SD, Kaplan PA, Dussault RG. Imaging of the knee. Current status. Orthop Clin North Am 1997; 28:643.
  27. Bureau NJ, Kaplan PA, Dussault RG. MRI of the knee: a simplified approach. Curr Probl Diagn Radiol 1995; 24:1.
  28. Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 2007; 84:5.
  29. Boden SD, Davis DO, Dina TS, et al. A prospective and blinded investigation of magnetic resonance imaging of the knee. Abnormal findings in asymptomatic subjects. Clin Orthop Relat Res 1992; :177.
  30. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008; 359:1108.
  31. Zanetti M, Pfirrmann CW, Schmid MR, et al. Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 2003; 181:635.
  32. Bouguennec N, Meyer A, Graveleau N. Localized form of pigmented villonodular synovitis of the knee: the meniscal mime. Orthop Traumatol Surg Res 2014; 100:251.
  33. Venkatachalam S, Godsiff SP, Harding ML. Review of the clinical results of arthroscopic meniscal repair. Knee 2001; 8:129.
  34. McNally EG, Nasser KN, Dawson S, Goh LA. Role of magnetic resonance imaging in the clinical management of the acutely locked knee. Skeletal Radiol 2002; 31:570.
  35. Helmark IC, Neergaard K, Krogsgaard MR. Traumatic knee extension deficit (the locked knee): can MRI reduce the need for arthroscopy? Knee Surg Sports Traumatol Arthrosc 2007; 15:863.
  36. Ménétrey J, Siegrist O, Fritschy D. Medial meniscectomy in patients over the age of fifty: a six year follow-up study. Swiss Surg 2002; 8:113.
  37. Suter LG, Fraenkel L, Losina E, et al. Medical decision making in patients with knee pain, meniscal tear, and osteoarthritis. Arthritis Rheum 2009; 61:1531.
  38. Boyd KT, Myers PT. Meniscus preservation; rationale, repair techniques and results. Knee 2003; 10:1.
  39. Howell JR, Handoll HH. Surgical treatment for meniscal injuries of the knee in adults. Cochrane Database Syst Rev 2000; :CD001353.
  40. Yoon KH, Park KH. Meniscal repair. Knee Surg Relat Res 2014; 26:68.
  41. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 2014; 42:3016.
  42. Ericsson YB, Dahlberg LE, Roos EM. Effects of functional exercise training on performance and muscle strength after meniscectomy: a randomized trial. Scand J Med Sci Sports 2009; 19:156.
  43. Morrissey MC, Goodwin PC, Klarneta M, et al. Factors related to early recovery rate after partial knee meniscectomy. Orthopedics 2008; 31:752.
  44. Stensrud S, Risberg MA, Roos EM. Knee function and knee muscle strength in middle-aged patients with degenerative meniscal tears eligible for arthroscopic partial meniscectomy. Br J Sports Med 2014; 48:784.
  45. Herrlin S, Hållander M, Wange P, et al. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007; 15:393.
  46. Kise NJ, Risberg MA, Stensrud S, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016; 354:i3740.
  47. Stensrud S, Risberg MA, Roos EM. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears: a 3-mo follow-up of a randomized controlled trial. Am J Phys Med Rehabil 2015; 94:460.
  48. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369:2515.
  49. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med 2015; 49:1229.
  50. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop 2014; 5:233.
  51. Khan M, Evaniew N, Bedi A, et al. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 2014; 186:1057.
  52. Weiss CB, Lundberg M, Hamberg P, et al. Non-operative treatment of meniscal tears. J Bone Joint Surg Am 1989; 71:811.
  53. Chatain F, Adeleine P, Chambat P, et al. A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 2003; 19:842.
  54. Fabricant PD, Jokl P. Surgical outcomes after arthroscopic partial meniscectomy. J Am Acad Orthop Surg 2007; 15:647.
  55. Stein T, Mehling AP, Welsch F, et al. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 2010; 38:1542.