膝关节髌下皱襞的临床意义

目的:观察膝关节镜下髌下皱襞结构的变化,探讨膝关节髌下皱襞的临床意义。方法:回顾性总结分析膝关节镜手术病例400例,男177例,女223例;年龄9⁷9岁,平均42岁。术前均有膝关节疼痛、肿胀和交锁等现象,保守治疗无效,行膝关节镜检查及镜下手术。术中证实单纯的髌下皱襞病变11例,术前有膝前区疼痛症状者8例,疼痛区域模糊不定者3例,膝关节反复肿胀、积液者2例;术前诊断为半月板损伤4例,关节软骨损伤2例,髌股关节骨性关节炎1例,髌下脂肪垫损伤4例。11例均行膝关节镜下髌下皱襞切除术。结果:400例膝关节镜手术中发现有髌下皱襞结构的284例（71%）;有髌下皱襞病变的52例（13%）,其中单纯的髌下皱襞病变11例（2.75%）。髌下皱襞病变镜下表现为髌下皱襞肿胀、增厚、纤维化、丧失弹性,与髁间凹产生撞击。11例单纯髌下皱襞病变均行关节镜下髌下皱襞切除术,术后随访9例,2例失访,随访时间3²4个月,平均14个月。疗效评定优7例,良1例,可1例,差0例,优良率88.89%。结论:髌下皱襞具有明确的临床意义,其病变可以引起临床症状。     

膝关节镜术后再次手术的原因

目的探讨膝关节镜术后再次手术的原因。方法对25例膝关节镜术后再次手术者行膝关节镜术16例,开放性滑膜切除术7例,全膝关节置换术2例。分析其再手术原因。结果软骨剥脱、滑膜病变残留或滑膜炎复发、漏诊半月板或交叉韧带损伤以及关节游离体是再手术中见到的主要病变。随访6个月-2年,16例膝关节镜术后机械性交锁症状均消失,7例行滑膜切除、2例人工全膝关节置换术者术后肿胀疼痛均消失。结论误漏诊、术前查体不细、适应证选择及手术处理不当是膝关节镜术后再次手术的主要原因。提高术前诊断水平、术中关节镜操作技术是减少再手术的关键。     

髌内侧滑膜皱襞撕裂的诊断及治疗

目的 :讨论髌内侧滑膜皱襞撕裂的诊断及治疗方法。方法 :698例关节镜检查中髌内侧滑膜皱襞撕裂者 34例 ,占 4 % ,均在局麻关节镜下行撕裂的滑膜皱襞切除术 ,术后在髌内侧滑膜皱襞的对应处用绷带加压包扎 2～ 3d。结果 :术后随访 2～ 1 0年 ,由髌内侧滑膜皱襞撕裂引起的疼痛均消失 ,膝关节功能恢复正常。结论 :关节镜下切除撕裂的髌内侧滑膜皱襞创伤小 ,恢复快 ,效果好     

膝关节镜下治疗髌股关节退行性变的方法探讨

目的:探讨膝关节镜下治疗髌股关节退行性变的方法.方法:327例患者,采用关节镜下手术治疗.对单纯髌骨软骨剥脱的病损行滑膜切除、髌骨软骨损伤区减压,对髌股关节四周有应力性劳损骨赘形成的病例行髌股关节四周应力区减压.结果:本组随访6个月～5年3个月.髌前疼痛缓解或消失298例.结论:膝关节镜下清理减压是治疗髌股关节退行性变的有效方法.     

髌内侧滑膜皱襞综合征的诊断和关节镜治疗

髌内侧滑膜皱襞 ,是一发育残留的滑膜皱襞 ,由髌上内侧延伸至髌下脂肪垫滑膜上方。我院自 1998年以来在膝关节镜下证实并行滑膜皱襞切除术治疗该征 2 1例取得满意效果 ,报告如下。1　临床资料1 1　一般资料　本组 2 1例 ,其中男性 15例 ,女性 6例 ;年龄 2 9～ 74岁 ,左膝 8例 ,右膝 13例 ;单纯髌内侧滑膜皱襞综合征 14例 ;合并其它病变者 7例 ,其中外侧半月板损伤 4例 ,髌股关节炎 3例 ;平均病程 18个月。1 2　诊断　所有患者均诉有膝前痛和屈膝时弹响 ,5例患者有“胶着”感 (即久坐后开始行走时膝关节痛 ,活动后疼痛消失 ) ,3例有抬腿乏力 …     

膝关节镜下治疗髌股关节退行性变的方法探讨

目的：探讨膝关节镜下治疗髌股关节退行性变的方法．方法：327例患者，采用关节镜下手术治疗。对单纯髌骨软骨剥脱的病损行滑膜切除、髌骨软骨损伤区减压，对髌股关节四周有应力性劳损骨赘形成的病例行髌股关节四周应力区减压。结果：本组随访6个月～5年3个月。髌前疼痛缓解或消失298例。结论：膝关节镜下清理减压是治疗髌股关节退行性变的有效方法。     

诊断不明膝关节交锁症的病因探讨和疗效观察

目的　探讨诊断不明膝关节交锁症的病因、症状特点 ,经关节镜治疗后的临床疗效。　方法　对 4 7例膝关节不明原因交锁的病例均施行关节镜检查。镜下发现的病变 :34例滑膜疾病、4例Hof fa病、9例髌股关节排列异常 ,滑膜疾病镜下刨削切除滑膜皱襞、增生肥厚的滑膜团块及滑膜瘤样病变 ,Hoffa病镜下部分切除髌下脂肪垫 ,髌骨半脱位行髌骨外侧支持带松解、胫骨结节前内侧移位。　结果　平均随访 1年 ,全部病例术后交锁症状消失 ,4 6例膝关节疼痛完全消失或明显缓解 ,术前存在膝关节功能障碍的大多数病例术后恢复或接近正常。　结论　诊断不明膝关节交锁症的原因较多 ,其主要病因是滑膜疾病、Haffa病、髌股关节排列异常。关节镜术是一个重要的诊断和治疗手段 ,并可获得满意的临床效果。     

膝关节镜术后再手术原因分析

目的探讨导致膝关节镜手术疗效差或术后复发的技术因素,以提高对膝关节病变的认识和手术技能。方法回顾性分析膝关节镜术后再手术特别是再次关节镜手术时的检查所见。1990年1月～2002年1月,由本人施行的2000余例膝关节镜手术中,有38例因初次膝关节镜术的适应证选择不当、疗效差或术后复发而再手术。38例患者于初次手术后3～108个月,平均(29.61±21.98)个月,进行再手术。初次手术年龄11～68岁,平均(45.8±12.9)岁。男12例,女26例;左膝13例,右膝25例。原发疾病包括骨性关节炎21例,滑膜炎7例,半月板损伤及其它病变10例。再手术的症状包括疼痛、机械性症状或肿胀。再手术方式仍优先选择关节镜,方法同初次手术。对于滑膜炎较严重者选择开放性滑膜切除术,对X线检查提示至少有两个间室关节间隙显著狭窄的年龄适宜的患者选择全膝关节置换术。结果再手术包括膝关节镜术24例,全膝关节置换术10例,开放性滑膜切除术4例。软骨剥脱、滑膜病变残留或滑膜炎复发、以及漏诊半月板损伤是再手术中见到的主要病变。9例重度骨性关节炎和1例类风湿关节炎行全膝关节置换术。1例骨性关节炎、2例色素沉着绒毛结节性滑膜炎和1例反应性关节炎行开放性滑膜切除术。术后至少随访6个月,疼痛、机械性症状和肿胀消失。结论膝关节镜术的临     

关节镜下治疗膝关节内侧滑膜皱襞综合征

目的探讨膝关节内侧滑膜皱襞综合征的临床诊断、治疗方法及结果。方法自2006年10月至2010年11月期间,我院共诊治膝关节内侧滑膜皱襞综合征患者87例,其中46例采取保守治疗后症状无缓解而接受关节镜下手术切除滑膜皱襞。男24例,女22例;年龄23～72岁,平均年龄为41岁。按Sakakibara法对滑膜皱襞进行分类,在关节镜下行皱襞切除术,并随访记录其疗效。结果 46例经关节镜下皱襞切除的患者,其中A型27例,B型15例,C型3例,D型1例;同时合并9例半月板损伤,5例髌股关节内侧面骨关节炎形成。增生的滑膜皱襞均采用篮钳或刨削器将其切除。43例获得随访,平均随访时间为25个月,无复发病例。膝关节功能根据Lysholm评分进行评定,术后功能较术前明显改善,治疗结果优良率为90.7%。结论膝关节内侧滑膜皱襞综合征根据临床症状和MRI表现即可诊断,关节镜下可以确诊,同时镜下行滑膜皱襞切除可获得满意的效果。     

髌内侧滑膜皱襞综合征的诊断和治疗

目的探讨髌内侧滑膜皱襞综合征的诊断及治疗方法。方法回顾性分析2004年10月～2006年11月收治的单纯髌内侧滑膜皱襞综合征37例。将其临床症状、体征与关节镜检查进行比较,探讨临床诊断治疗方法。结果经关节镜检查证实,单纯膝关节滑膜皱襞综合征37例,其中术前诊断半月板损伤而术后诊断滑膜皱襞5例;滑膜皱襞B型4例,C型25例,D型8例。关节镜下动态观察,发现可解释症状的有病理改变的滑膜皱襞即可诊断。术后随访时间3～48个月,关节功能优良达89.2%,手术后无症状加重或感染病例,疗效与伴随的软骨损伤程度呈负相关。结论早期髌内侧膝关节滑膜皱襞综合征临床诊断较困难,认真详细的体格检查及造影后MRI检查有助于提高诊断准确率,关节镜是诊断和治疗髌内侧滑膜皱襞综合征的最佳方法。     

Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis

Purpose

To investigate the knee arthroscopic findings of pediatric patients with knee pain.

Subjects

Ninety-five knees of 94 patients (46 males and 48 females) aged 15 years or younger who underwent knee arthroscopy during a 4-year period from January 2007 were studied. The mean age at surgery was 13.5 (7–15) years. The mean interval from symptom onset to arthroscopic examination was 6.8 months (5 days to 2 years 10 months).

Results

The most common cause of knee pain was sports-related activities (64 knees). Other causes included falling from a moving bicycle (5 knees), while knee pain appeared with no defined reason in 14 knees. The most frequent final diagnosis based on knee arthroscopic findings was anterior cruciate ligament (ACL) injury (35 knees), followed by discoid lateral meniscus (16 knees), lateral meniscal tear (11 knees), and medial plica syndrome (9 knees), while no arthroscopic abnormality was observed in 8 of 95 knees. Among the 95 knees, the diagnosis based on preoperative physical tests and imaging findings was different from the arthroscopic diagnosis in 16 knees, 8 of which were diagnosed preoperatively as medial meniscal tear.

Conclusion

ACL injury and discoid lateral meniscus were the predominant conditions in pediatric patients who underwent knee arthroscopic surgery for knee pain. Knee arthroscopy is useful to provide a definitive diagnosis for knee pain in pediatric patients. Preoperative evaluations had a diagnostic accuracy of only 83.2 % and failed to diagnose conditions such as medial plica syndrome and chondral injury. Therefore, diagnosis before knee arthroscopy has to be interpreted with caution.     

Clinical diagnosis of medial plica syndrome of the knee: a prospective study

Clinical diagnosis of symptomatic medial plica that causes anteromedial knee pain is poorly defined in the literature; therefore, arthroscopy is considered to be the gold standard for diagnosing this condition. We report our system of clinical diagnosis for medial plica syndrome that is based on patient history and our criteria for clinical examination. This prospective study included 48 symptomatic patients (66 knees) with clinical suspicion of pathological medial plica based on five essential and four desirable criteria. All patients underwent arthroscopic examination to confirm or disprove the clinical diagnosis and also treatment. Arthroscopy confirmed the clinical diagnosis of medial plicae in 44 patients (62 knees) for a diagnostic accuracy of 91.7% (95% confidence interval [CI]: 80% to 97.7%) and sensitivity of 100% (95% CI: 92% to 100%). The 44 patients with pathological medial plicae at arthroscopy were treated by arthroscopic resection. Thirty-nine patients (55 knees) showed satisfactory outcome after arthroscopy (95% CI: 75.4%, 96.2%). Our method of clinical diagnosis of pathological medial plica is simple, inexpensive, noninvasive, and reliable. We conclude arthroscopy is successful in treating this condition.     

Arthroscopic studies of variants of the anterior horn of the medial meniscus

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992 and March 1995, arthroscopy was performed on 953 knees of 903 patients. At the time of this examination, observation and probing were performed to determine the condition of the synovium, the synovial plica, the cartilage in all compartments, the meniscus, the cruciate ligaments, and the popliteal tendon. In particular, detailed examination was made of the anterior horn of the medial meniscus with regard to the point of insertion to the tibia and the degree of movement in knee flexion/ extension. Cases of VAMM diagnosed on the basis of the arthroscopic findings were classified into the following four categories: the ACL (anterior cruciate ligament) type, where the anterior horn of the medial meniscus was attached to the ACL; the transverse ligament type, where the anterior horn of the medial meniscus was attached to the transverse ligament; the coronary ligament type, where the anterior horn of the medial meniscus was attached to the coronary ligament; and the infrapatellar fold type, where the anterior horn of the medial meniscus was attached to the infrapatellar synovial fold. These patients were then analyzed with regard to the arthroscopic findings and the intra-articular lesions other than VAMM. In 98 (10.9%) of the total patients, 103 knees were classified as VAMM. Classification of those 103 knees using the above criteria showed 39 ACL type knees, 51 transverse ligament type knees, 11 coronary ligament type knees, and 2 infrapatellar fold type knees. The arthroscopic findings indicated that the anterior horn of the medial meniscus was not attached directly to the tibia in any of these knees. Probing and flexion/extension of the knee revealed hypermobility at the anterior horn of the medial meniscus. In this study, anterior knee pain syndrome was diagnosed in 12 (11.7%) of the 103 VAMM knees. In addition, there was no clear history of trauma in 20 of 23 knees found to have an isolated medial meniscus tear. In these cases, even detailed arthroscopic observation proved the causes of the symptoms or injury. On the basis of these findings, we surmised that the anterior portion shows hypermobility at the time of flexion/extension of the knee, regardless of the type of VAMM. In this study, we discussed the possibility that the existence of VAMM may become the cause of pain or injury to the meniscus.     

Arthroscopic anatomy of the infrapatellar plica

The infrapatellar plicae, ligamentum mucosum, were examined by arthroscopy in 200 knees. They were classified into five patterns according to the characteristics of the morphologic findings: separate type in 121 cases (60.5%), split type in 27 cases (13.5%), vertical septum type in 21 cases (10.5%), and fenestra type in 2 cases (1.0%). The remaining 29 cases (14.5%) did not have any infrapatellar plica, which were defined as absent type. Hence, the incidence of the infrapatellar plica was 85.5% of the 200 knees examined. There was no significant difference between right and left knees in the distribution pattern of the plica types. The incidence of the intrapatellar plicae decreased as the age increased. Both knees showed the same pattern in the 9 of 16 cases in which a bilateral comparison of the infrapatellar plicae was made.     

髌内侧滑膜皱襞综合征为主的膝关节内紊乱

目的:通过临床病例观察,探讨膝内侧滑膜皱襞综合征的诊断、类型及与半月板损伤、软骨损害的关系,分析膝内侧滑膜皱襞综合征的特点及在骨性关节炎发病中所起的作用。方法:关节镜下治疗内侧滑膜皱襞综合征患者48例(53膝),其中男13例(13膝),女35例(40膝);年龄16~71岁,平均56岁;病程1个月~10年,平均26个月。48例于关节镜直视下观察并手术切除滑膜皱襞,处理相应病变。采用Lysholm膝关节量表记分法评价疗效。观察症状体征与实际病损的关系,计算术前与术中诊断的符合率。关节镜下观察症状性滑膜皱襞的部位、性状、分型及软骨磨损的部位和分级,分析增生的滑膜皱襞与半月板损伤、软骨损害的关系。对术前后Lysholm评分采用SPSS13.0统计软件进行统计学处理。结果:常见的软骨缺损有股骨内髁内侧的沟槽状缺损及股骨内侧滑车的类圆形缺损。软骨退变以股骨内髁非负重区为主,占总数的54.29%;以股骨滑车内侧次之,占40.00%;以髌骨内侧关节面为主的缺损居第3位,占5.71%。术后48例53膝均获随访,随访时间17个月~4年,平均28个月。Lysholm膝关节评分:术前平均(41.00±7.03)分,术后平均(85.00±8.01)分(t=-26.17,P<0.001),证明关节镜治疗效果显著。本组优(>90分)12膝,良(80~90分)37膝,可(70~79分)4膝,优良率92.45%,无复发及二次手术者。结论:通过关节镜下特征性改变可以对内侧滑膜皱襞综合征做出明确诊断,股骨内髁及滑车软骨的沟槽状及类圆形磨损是2种典型的皱襞引起的软骨缺损。镜下切除滑膜皱襞疗效满意,对防止软骨进一步损害有积极的意义。     

膝关节滑膜软骨瘤病28例诊治体会

目的:探讨膝关节镜下膝关节滑膜软骨瘤病的诊断和治疗效果。方法:自1995年3月至2011年7月治疗滑膜软骨瘤病患者28例,其中男18例,女10例;年龄25～81岁,平均55.2岁;病程0.5～15年,平均5.6年。症状主要为膝关节疼痛、肿胀和功能受限。分别采用膝关节开放手术(17例)和膝关节镜手术(10例)进行治疗。观察其临床症状、影像学、病理表现及关节镜下的治疗效果。采用膝关节Lysholm评分对治疗前后的疗效进行评价。结果:27例获随访(1例失访),时间6～24个月。开放手术患者膝关节Lysholm评分由术前的(41.89±6.81)分增加到术后的(67.73±7.62)分;关节镜组患者膝关节Lysholm评分由术前的(40.78±7.54)分增加到术后的(77.46±8.43)分。结论:关节镜手术无切口裂开、不愈合等危险,术后可以早期功能锻炼,是诊断和治疗膝关节滑膜软骨瘤病的良好方法。     

The clinical significance of the complete type of suprapatellar membrane

The plicae are synovial septa remaining in adult life that existed in early fetal life. The suprapatellar plica separates the suprapatellar pouch from the knee joint. The plica syndrome has clinical significance, which has been occasionally overlooked, but the pathophysiology of symptomatic plicae may be hard to explain. To evaluate the clinical significance of the suprapatellar plicae, the authors reviewed 34 cases in 23 patients with vague pain around the knee and a total septum of the suprapatellar plica at arthroscopic examination from September 1991 to December 1993. The follow-up period was from 6 months to 2 years and 9 months. The most common presenting symptom was chronic mild knee pain, aggravated by prolonged squatting or standing, with other patients reporting recurrent swelling, instability, giving-way, or a feeling of snapping. The objective findings include palpable band on the superomedial side, audible snapping, and local tenderness, but there were no significant abnormal findings in the laboratory. The radiographic findings were few, with sclerosis of the articular surface of the patella in 2(6%), malalignment in 1(3%), and mild degenerative change in 4 cases(12%). Five of 11 patients evaluated by bone scan had increased uptake around the patellofemoral joint, and 7 of 13 knees had a relatively small suprapatellar bursa on conventional arthrogram or pneumoarthrogram. At arthroscopy, a suprapatellar plicae with complete septum was identified in 30 of 34 cases (88%) and associated lesions presented as meniscal tears, loose body, and discoid meniscus without tear. The complete plicae were surgically excised under arthroscopic control in 30 patients and the results were excellent in 22 patients (73%), good in 5 (17%), and poor in 3 (10%)at 17 months follow-up; there were no failures. In our opinion, the complete suprapatellar plica is clinically significant in patients who have equivocal diagnosis of knee problems and further studies of the pathophysiology of complete suprapatellar plica are needed. (Arthroscopy 1998 Nov-Dec;14(8):830-5.)     

Arthroscopic treatment of symptomatic type D medial plica

We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our series were classified as fenestrated (14 knees), torn (5 knees), or reduplicated (4 knees). Fibrotic changes in the plicae and degenerative changes on the medial femoral condyle were found in 16 knees Patellofemoral chondromalacia was present in three knees Arthroscopic partial resection was performed in all patients. Comparative Lysholm Knee Scale scores before and after surgery revealed a significant clinical improvement (pre-operative status, 67.19 ± 8.05 vs. post-operative status, 90.57 ± 9.80; P < 0.001). Type D medial plica should be considered as a possible cause of chronic knee pain. Arthroscopic partial resection of the plicae in symptomatic patients gives satisfactory results. Research was performed at the Medical Faculties of Baskent University and Istanbul University.     

关节镜清理术治疗膝关节骨关节炎

目的：探讨关节镜下清理术对膝关节炎的诊断价值及治疗效果。方法：作者自1995年5月至1999年5月采用关节镜下清理术治疗膝关节骨关节炎患者56例（70膝）,随访6月－4年。结果：本组病人56例（70膝）,经关节镜检查均证实有关骨节炎存在,而术前X线片有关破坏的仅36膝,符合率为51．4％。本组病人术后疼痛明显减轻,2－3周即下床活动,随访1年优良率91％,2年以后优良率67．8％。结论：关节镜下清理术膝关节骨关节炎可以有效缓解病人的疼痛,可以早期恢复关节的功能,延迟骨关节炎的病程,全面提高诊断的准确率。