美国矫形外科学会关于半月板损伤的治疗医患须知
2018年08月09日 【健康号】 许树柴     阅读 7635

广州中医药大学附属广东省中医院骨科  许树柴主任   翻译整理

Meniscal Tears

半月板撕裂

Your knee is the largest joint in your body and one of the most complex. Because you use it so much, it is vulnerable to injury. Because it is made up of so many parts, many different things can go wrong.广东省中医院骨科许树柴

膝关节是在身体最大和最复杂的一个关节。因为我们经常使用膝关节,故很容易受伤。它构成复杂,故很多部位很容易损坏。

Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.

半月板撕裂是最常见的膝关节损伤之一。运动员,特别是那些身体接触较多的运动,很容易导致半月板撕裂。然而,任何人在任何年龄均可发生半月板撕裂。当人们谈论膝盖的软骨撕裂,他们通常指的是半月板撕裂。

Anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella).

膝关节涵盖三块相邻的骨:股骨(大腿骨),胫骨,以及膝盖骨(髌骨)。

Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

两个楔形软骨在股骨和胫骨之间作为“减震器”。称为半月板。他们是坚韧和质软的,可以帮助缓解关节受力和保持稳定。

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Description

特点

Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex.

半月板撕裂的方式不同。半月板撕裂通常可以从外形看得出来具体撕裂部位。常见的撕裂包括纵裂、斜裂、层裂、提篮样和混合/复杂撕裂。

Sports-related meniscal tears often occur along with other knee injuries, such as anterior cruciate ligament tears.

与体育相关的半月板撕裂经常发生与其他膝关节损伤一起发生,如前十字韧带撕裂。

Cause

半月板撕裂的原因

Sudden meniscal tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

突如其来的半月板撕裂经常发生在运动损伤。运动员在蹲下和扭曲膝盖时可以造成撕裂。直接接触,例如铲球的动作,亦可以导致撕裂。

Older people are more likely to have degenerative meniscal tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

年纪大的人更容易有退行性半月板撕裂。随着时间的推移,软骨慢慢减弱变薄,老的、破旧的组织更容易撕裂。如果半月板已经随着年龄的增长老化,只是从椅子站起来,可能就足以造成撕裂,。

Symptoms

症状

You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.

The most common symptoms of meniscal tear are:

你可能会觉得“啪”的一声当你撕裂半月板的时候。大多数人受伤后还是可以走路的。许多运动员即使半月板撕裂依然继续运动。超过2~3天,你的膝关节会逐渐变得更加僵硬和肿胀。

半月板撕裂的最常见的症状是:

· Pain    疼痛

· Stiffness and swelling     关节僵硬和肿胀

· Catching or locking of your knee    关节交锁

· The sensation of your knee "giving way"       关节松动感

· You are not able to move your knee through its full range of motion

· 活动受限

Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.

如果不进行治疗,半月板可能会松动和漂移进入关节腔。这可能会导致你的膝关节不稳或交锁。

Doctor Examination     检查

Physical Examination and Patient History      查体及病史

After discussing your symptoms and medical history, your doctor will examine your knee. He or she will check for tenderness along the joint line where the meniscus sits. This often signals a tear.

了解你的症状和病史后,医生会检查你的膝关节。他会沿着关节的半月板检查压痛。压痛部位往往就是撕裂部位。

One of the main tests for meniscal tears is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your knee will click each time your doctor does the test.

麦氏征是最重要的半月板撕裂的检查之一。医生弯曲你的膝盖,然后伸直和旋转。这使得撕裂的半月板紧张。如果你有半月板撕裂,这个动作将导致关节有响声。每次医生检查时你的膝关节都会响。

Imaging Tests     影像学检查

Because other knee problems cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis.

因为其他的膝关节问题可以导致类似的症状,医生可能会要求影像学检查,以帮助明确诊断。

X-rays. Although X-rays do not show meniscal tears, they may show other causes of knee pain, such as osteoarthritis.

X射线:虽然X射线不显示半月板撕裂,但可以显示出膝盖疼痛其他原因,例如骨关节炎。

Magnetic resonance imaging (MRI). This study can create better images of the soft tissues of your knee joint.

磁共振成像(MRI)。这项检查可以更好地显示你的膝盖关节的软组织。

Treatment

治疗

How your orthopaedic surgeon treats your tear will depend on the type of tear you have, its size, and location.

医生会根据你撕裂的类型、大小和具体位置来决定你的治疗方案。

The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.

半月板的外三分之一具有丰富的血液供应。在这个“红”区,半月板撕裂可能可以自愈,亦可以进行手术修复。纵向撕裂就是这种撕裂的一个例子。

In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.

与此相反,半月板的内三分之二缺乏血液供应。因为缺乏血液的供应,在这个“白”区内的撕裂不能愈合。这些复杂的撕裂往往发生在薄的、磨损的地方。由于这两块不能重新生长起来,在这个区域内撕裂通常需要手术削去。

Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.

你撕裂的类型、年龄、活动量以及任何与损伤相关的因素都将成为你治疗计划的参考。

Nonsurgical Treatment    非手术治疗

If your tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need.

如果你撕裂的范围小,并在半月板的外侧缘,可能不需要手术修复。只要你的症状没有持续,你的膝关节是稳定的,非手术治疗可能是你所需要的。

RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

RICERICE原则对于大多数运动相关的损害是有效的。RICE表示休息、冰敷、加压包扎和抬高患肢。

· Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.

· 休息。损伤后停止活动,进行休息。医生可能会建议您使用拐杖避免患肢负重。

· Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.

· 冰敷。用冰袋冷敷20分钟,每天数次。不要直接在皮肤上敷冰。

· Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.

· 加压包扎。为了避免额外的肿胀和出血,用的弹性压缩绷带加压包扎。

· Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.

· 抬高患肢。为了减轻肿胀,当你休息把你的腿抬起比你的心脏高。

Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.

非甾体抗炎药物。如阿司匹林布洛芬等药物减轻疼痛和肿胀。

Surgical Treatmen

手术治疗t

If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.

经非手术治疗后,如果你的症状扔持续存在,医生可能会建议关节镜手术。

Procedure. Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the tear.

手术:膝关节镜手术是最常见的外科手术之一。在这里面,一个微型摄像头通过一个小切口插入。提供膝关节的内部的清晰视图。骨科医生通过其他的小切口插入微型手术器械修整或修复撕裂的半月板。



Rehabilitation. After surgery, your doctor may put your knee in a cast or brace to keep it from moving.

康复:术后,医生可能会在你的膝关节上石膏或支具以制动。

Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.

一旦最初的治疗完成后,医生会开始叫你进行康复锻炼。有规律的锻炼对于恢复你的膝关节流动性和强度是必要的。你将开始练习使你的运动范围增大。您的康复计划将包括加强功能锻炼。

For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy.

在大多数情况下,虽然医生可能会建议物理治疗,康复亦可以在家里进行。


Recovery    预后

Meniscal tears are extremely common knee injuries. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities.

半月板撕裂是非常常见的膝关节损伤。有了正确的诊断,治疗和康复,患者一般可以恢复到受伤前的功能。


     



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