| Abstract | Cilj istraživanja: Incidencija ozljeda meniska je u porastu u pedijatrijskoj populaciji. Postoje snažni dokazi da meniscektomija u djece pospješuje razvoj osteoartritisa koljena, pa su se tako u proteklih dvadeset godina tehnike popravka ruptura meniska razvile u smjeru očuvanja tkiva i funkcije meniska. Cilj ovog istraživanja je bio analizirati epidemiološke, demografske, kliničke karakteristike i ishod bolesnika operiranih zbog ozljeda meniska te unutar ispitanika usporediti dvije skupine bolesnika operiranih različitim tehnikama popravka meniska.
Ispitanici i metode: Ispitanici su svi bolesnici operirani u Zavodu za dječju kirurgiju KBC Split zbog ozlijede meniska od 1. siječnja 2006. do 1. lipnja 2016. godine. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, mehanizam nastanka ozlijede, lateralizacija ozlijede i meniska, anatomska lokalizacija ozljede i pridružene ozlijede. Ispitanicima koji su podvrgnuti tehnikama popravka meniska analizirani su još i vrsta kirurške tehnike popravka meniska, vrijeme trajanja operacije, duljina hospitalizacije, rezultati subjektivne evaluacije 4 tjedna nakon operacije putem Lysholm i IKDC upitnika te komplikacije nakon operacije.
Rezultati: istraživanje je obuhvatilo 102 bolesnika operiranih zbog ozlijede meniska. Od ukupnog broja bolesnika u 24 bolesnika je učinjena resekcija meniska, u 36 bolesnika „shaving“ meniska, 21 bolesnik operiran je tehnikom postavljanja šavova i 21 bolesnik operiran fiksacijom meniska strelicama. Dječaci su češće operirani od djevojčica u odnosu 2:1, a prosječna dob operiranih je bila 16 godina. Medijalni menisk (62%) i desno koljeno (58%) su češće zahvaćeni ozljedom. Najčešća anatomska lokalizacija ozljede meniska su prednji rog (36%) i tijelo meniska (36%), a među ozljedama srednjeg djela meniska, najčešća je ozljeda po tipu „Bucket-handle“ (84%). Sport (87%) ima najvišu incidenciju kao uzrok ozljede meniska, a nogomet (33%) je najčešći među sportovima. Između skupine bolesnika operiranih tehnikom postavljanja šavova i tehnikom fiksacije meniska strelicama nije bilo značajne razlike između promatranih ishoda liječenja, osim za anatomsku lokalizaciju ozljede (p=0.035). Medijani operacijskog vremena u skupinama bolesnika operiranih tehnikama popravka meniska bili su 62.5 i 70 minuta (p=0.184). Medijan duljine hospitalizacije bio je 3 dana za obje skupine (p=0.951). Medijan vrijednosti Lysholm ljestvice za promatrane skupine bio je 86.5 i 84.5 (p=0.651) i IKDC ljestvice 81.05 i 81.6 (p=0.986).
Zaključci: Poznavajući štetne učinke meniscektomije, tehnika popravka meniska je dugoročnije bolji odabir i trebala bi se provoditi kad god je to moguće. Obje tehnike (tehnika postavljanja šavova i tehnike fiksacije meniska strelicama) su sigurne i uspješne u liječenju ruptura meniska u djece, bez značajnijih komplikacija te s dobrim dugoročnim rezultatima. |
| Abstract (english) | Objectives and background: Incidence of meniscal lesions is increasing in the pediatric population. There is strong evidence that meniscectomy in pediatric patients induces the development of premature osteoarthritis, so given the harmful impact of meniscectomy, meniscal repair is attempted whenever possible. The aim of this study was to analyze epidemiologic, demographic, clinical characteristics, outcomes in patients with arthroscopic management of meniscal injuries and to compare two groups of patients that have undergone different techniques of meniscal repair.
Patients and Methods: From January 2006 until June 2016 case records of 102 patients who underwent arthroscopic management of meniscal injuries were retrospectively reviewed. Each patient was analyzed for following parameters: age, gender, mechanisms of injury, side of injury and injured meniscus, injury localization regarding anatomic position, injury type and associated injuries. The patients that underwent meniscal repair were analyzed for type of repair technique, operating results and the results of follow-up (Lysholm and IKDC score).
Results: The study included 102 patients who underwent arthroscopic management of meniscal injuries. There were 24 patients with meniscal resection, 36 patients with meniscus „shaving“, 21 patient with suture technique and 21 patient with meniscal dart technique. The male to female ratio was 2:1 and mean age was 16. Medial meniscus (62%) and right leg (58) were predominantly injured. The anterior segment was involved in 36% cases, the middle segment in 36% cases and among middle segment injuries there were 84% bucket-handle tears. Mechanisms of injury included sports-related accidents in 89% of the cases and football (33%) had the highest incidence among sports. In patients that underwent meniscal repair, statistically significant differences regarding clinical outcomes were not found, but differences between groups were found in anatomic injury localization (p=0.035). Median of operation time was 62.5 and 70 minutes for two groups (p=0.184), median of hospital stay was 3 days for both groups (p=0.951), median of Lysholm score was 86.5 and 84.5 (p=0.651) and median of IKDC score was 81.05 and 81.6, respectively (p=0.986).
Conclusions: Understanding the harmful impact of meniscectomy, arthroscopic meniscal repair should be attempted whenever possible. Our data support routine arthroscopic repair of meniscal tears, since the suture technique as the meniscal dart techniques are safe and successful in meniscal repair, with good long-term results and without important complications. |
