关节镜下半月板损伤修复的治疗方法

目的探讨关节镜下半月板损伤缝合修复术的治疗方法和效果。方法1998年6月~2003年5月,收治110例膝半月板损伤患者。其中男78例,女32例。年龄14~66岁,平均27.5岁。半月板滑膜缘纵裂93例,横裂12例,潜行撕裂5例。半月板损伤部位侧缘损伤78例,近前角部损伤23例,近后角部损伤9例。术前Lysholm评分为57±12分。均在关节镜下应用可吸收缝线缝合修复损伤的半月板,其中2针91例,4针13例,6针4例,8针2例。术后行康复训练及随访观察效果。结果术后关节无血肿、伤口期愈合。全部获随访12~67个月,平均26个月。3例患者劳累后出现膝关节胀痛,1例半月板损伤症状再出现,再手术探查见半月板缝合处未完全愈合,行半月板部分切除,术后痊愈。其余患者症状消失,关节功能良好。术后Lysholm评分为92±7分。结论关节镜下半月板损伤缝合修复术安全、可靠、操作简便。缝线吸收后,避免对半月板的制约,使愈合的半月板更好地发挥其生理和生物力学功能。     

应用Fast—Fix关节镜下修复半月板损伤

目的探讨Fast—Fix在关节镜下半月板损伤修复中的应用,并尝试对其手术技巧与疗效进行相关分析。方法选择本组59例在关节镜下应用Fast—Fix半月板缝合装置缝合的半月板撕裂的患者,其中陈旧性损伤31例,新鲜损伤28例,应用Fast—Fix缝合数目1～3个。术后根据MRI随访,并进行膝关节Lysholm评分及膝关节半月板损伤后JOY疗效评分。结果半月板平均缝合时间为5min。患者平均随访15个月,术后3个月MRI复查,半月板愈合率91％。术后患者的膝关节Lysholm评分、JOY疗效评分与术前比较,差异有统计学意义（t=5．215,P〈0．01）,疗效的优良率为89％。结论应用Fast—Fix在关节镜下行半月板撕裂缝合,方法简便,易于操作,固定牢靠,术后半月板愈合率高,是一种方便、有效的完全关节镜下半月板缝合技术。     

关节镜下半月板缝合术治疗中年人半月板损伤的疗效评估

目的:观察关节镜下半月板缝合术治疗中年人半月板损伤的临床疗效及愈合情况。方法 :自2014年3月至2015年1月,对40例符合纳入标准的中年膝关节半月板损伤患者采用关节镜下半月板缝合术进行治疗,男24例,女16例;平均年龄(52.65±3.63)岁(50~60岁);左膝28例,右膝12例;屈曲角(117.50±7.16)°(110°~130°)。术前膝关节Lysholm评分54.30±14.72(23~71分),IKDC评分50.65±15.95(18~78分),WOMAC评分23.80±19.39(2~75分)。均采用关节镜下全关节内半月板缝合术,术后以临床评分及MRI检查来评估疗效。结果:所有手术成功,未见严重并发症。术后随访6~12个月,无失访病例。所有患者保持5级肌力,膝关节活动度正常,能完全伸直及完全屈曲。40例平均屈曲角(125.00±5.13)°(110°~130°),较术前改善(t=-3.47,P=0.003)。终末随访膝关节Lysholm、IKDC及WOMAC评分分别为79.50±8.70(t=-7.790,P=0.000),79.40±10.40(t=-8.431,P=0.000),8.15±6.77(t=3.988,P=0.001),均较术前改善。MRI随访完全愈合4例,部分愈合22例,未愈合14例。损伤较小缝合3针及以下者,不愈合率为27.3%(6/22);损伤较大缝合大于3针者,不愈合率为44.4%(8/18)。结论:关节镜下半月板缝合术治疗中年人单纯半月板损伤疗效良好。术后不愈合率达35%,中年人半月板愈合能力较差。损伤较小者愈合率相对较高,损伤越大愈合率越低。     

囊肿切除联合撕裂半月板缝合术治疗半月板囊肿的临床研究

[目的]探讨关节镜下半月板囊肿切除后联合半月板撕裂全关节内缝合技术的临床应用特点.[方法]2006年8月～2008年5月共收集19例外侧半月板囊肿病例,其中男7例,女12例,通过MRI检查:其中半月板撕裂合并半月板囊肿14例,单纯滑膜囊肿5例,最终关节镜下诊断半月板撕裂合并半月板囊肿15例,单纯滑膜囊肿4例,通过关节镜将囊肿切除后,利用肩关节镜缝合器械将损伤的半月板缝合,继而进行有效的康复计划.然后应用Lysholm评分系统对术前术后的关节功能进行比较.[结果]平均随访20.5个月,所有病例恢复了正常的运动,没有发现关节内或关节外的术后并发症的产生.Lysholm scores 术前平均(64±5)分,术后平均(94±3)分.应用Studeng-t检验术前和术后的关节功能评分有显著的差异(P＜0.001).其中13例镜下随访发现11例完全愈合,2例不完全愈合.[结论]关节镜下半月板囊肿切除后联合半月板撕裂全关节内缝合技术(all-inside)无论在操作方面还是半月板的愈合方面都是一种简单有效的方法,是关节镜技术的一项创新和发展.     

关节镜下快速缝合装置修复半月板撕裂的临床评价

目的评价半月板快速缝合装置(Fast-Fix系统)在关节镜下半月板损伤修复中的临床效果。方法收治半月板撕裂患者69例,术中应用Fast-Fix系统缝合半月板撕裂。结果患者平均随访15个月,术后3个月MRI复查,半月板愈合率92%。术后患者的膝关节Lysholm评分、JOY疗效评分显著高于术前(P0.01),疗效优良率为88%。结论应用半月板快速缝合装置在关节镜下行半月板撕裂缝合,操作简单,损伤小,固定牢靠,术后半月板愈合率高。     

关节镜下抽吸式半月板缝合术患者的康复护理

目的 探讨半月板损伤患者行关节镜下抽吸式半月板缝合术患者的康复训练方法和初步疗效.方法 对26例半月板损伤患者采用关节镜下抽吸式半月板缝合术,术前指导其进行增强股四头肌的肌力、增加膝关节活动度的训练,术后指导其行肌力训练、提高膝关节屈曲度的训练及负重训练、下楼梯训练.结果 术后住院6～8 d,平均7.5 d,伤口Ⅰ期愈合、关节活动度>90°出院;随访6～54周,25例症状消失,步态正常,恢复正常工作和生活;1例合并膝骨性关节炎,内侧副韧带损伤,术后关节肿痛,予以制动,手术后23周膝屈曲<100°.结论 关节镜下抽吸式半月板缝合术后,在康复训练时科学地掌握手术后关节的动静关系、时机和局部情况,对确保手术效果,促进半月板愈合,恢复膝关节的功能有重要的临床意义.     

半月板组织工程的研究进展

半月板损伤临床常见,据美国矫形外科学会2008年的统计资料,美国每年全膝关节置换手术＆gt;250000例,其中半月板损伤是骨性关节炎进展的关键因素。然而,半月板仅外周1/3有血液供应,发生于此部位的损伤采用缝合治疗可以愈合;而内侧缘2/3均为无血管区,损伤后自行愈合能力较差,目前临床上针对这类损伤多采用半月板部分切除或全部切除术。     

膝关节半月板损伤的手术修复疗效观察

目的探讨切开直视下及关节镜下缝合修复半月板损伤的疗效及术后并发症发生情况。方法1988年1月～2004年6月采用切开直接缝合法和关节镜下缝合修补方法修复半月板损伤168例170个。关节镜下方法包括穿刺打磨修复法、可吸收半月板箭复位固定法、Outside-In缝合法、Inside-Out缝合法、Elite肩袖缝合器缝合法、T-Fix固定技术和FasT-Fix固定技术。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果进行评价,并对术后的并发症进行观察。对有明显症状及体征的患者进行关节镜探查。结果所有患者获得6个月～9．5年(平均49．3±28．8个月)随访发现,Tegner评分：术前3．3±2．3,术后6．8±2．1(p＜0．05)。Lysholm评分：术前30．1±18．2,术后87．5±22．5(P＜0．01)。按Molster对Lysholm评分的分级方法,优98个,良57个,可10个,差5个,优良率为91．2%。对术后症状和体征明显的19例患者进行关节镜再探查,发现5例术愈合,6例部分愈合。术后并发症包括Outside-In缝线打结处疼痛3例,外侧半月板前角Outside-In缝合后未愈合导致后关节囊牵拉痛1例,半月板箭固定处的后关节囊刺痛5例。无严重血管、神经损伤,术后并发症的总发生率为5．3%。结论选择适当方法对损伤半月板进行修复可明显改善膝关节的症状和功能评分,并且具有较高的手术成功率和较少的术中、术后风险。     

FasT-fix技术联合外-内缝合系统治疗膝半月板损伤疗效评估

【摘要】〓目的〓评价内缝合FasT-fix技术联合外-内缝合系统治疗膝关节半月板损伤的有效性。方法〓回顾性分析我院2011年2月至2014年2月利用关节镜下FasT-fix技术联合外-内缝合系统治疗膝半月板损伤83例。术后跟踪随访,通过MRI检查评估愈合情况,术前-术后Lysholm评分评估关节功能,探讨手术方式有效性。结果〓83例均获得随访并进行MRI复查,最长26个月,最短6个月(平均16个月),术后复查MRI提示59例完全愈合,16例部分愈合,8例未愈合。所有患膝关节活动度正常,平均Lysholm评分由术前46.3±20.8提高到93.5±4.6分(t=19.28, P<0.01),差异有统计学意义。结论〓关节镜下全内缝合FasT-fix技术联合外-内缝合系统治疗膝关节半月板损伤疗效肯定。     

关节镜下应用全内和外内缝合法治疗半月板损伤的临床研究

目的评价膝关节镜下应用全内和外内缝合法治疗半月板损伤的手术治疗效果。方法63例半月板撕裂伤患者在关节镜下进行半月板缝合术,对前角及体前、中部损伤采用由外向内缝合法,对后角及体后部损伤采用全内半月板缝合方法。结果全部病例经12～18个月随访,膝关节无症状率达93％。本组Lysholm膝关节功能评分术前（42．23±5．56）分,术后6个月提高到（91．35±2．72）分,两者比较差异有统计学意义（P〈o．01）。结论关节镜下半月板缝合术具有损伤小及愈合率高等优点。     

Meniscal repair enhanced by an interpositional free synovial autograft: An experimental study in rabbits

This report describes the methods and effectiveness of interpositional free synovial autografts (IPFSAs) in promoting the healing of lesions in the avascular portion of the knee joint meniscus in rabbits. Thirty-four specimens were divided into two groups: 17 in the study group and 17 in the control group. The medial meniscus of the left knee joint was excised in each rabbit, and an artificial longitudinal tear was created in the avascular zone of the meniscus. In the study group, an IPFSA was sewn into the tear with a single horizontal suture. In the control group, the tear was repaired without synovium in the same manner. The menisci were then implanted into the right knee joint in the respective animals. At intervals the animals were killed, and the menisci were examined grossly and microscopically. Three menisci were eliminated because they had become attached to the synovial wall. In the study group, the lesion completely healed by 4 weeks, except for one. The menisci in the control group never completely healed, particularly at the deeper levels of the lesion. At 8–16 weeks, autolysis of the specimens made microscopic examination difficult and unreliable in both groups. Based on these results, it has been concluded that an IPFSA can promote the healing process in the avascular zone of a torn meniscus in rabbits and that systemic vascularity to the synovium or the meniscus is not essential for healing to occur.     

A comparison of single-versus double-row suture anchor techniques in a simulated repair of the rotator cuff: an experimental study in rabbits

We compared time-dependent changes in the biomechanical properties of single-and double-row repair of a simulated acute tear of the rotator cuff in rabbits to determine the effect of the fixation techniques on the healing process. A tear of the supraspinatus tendon was created in 80 rabbits which were separated into two equal groups. A single-row repair with two suture anchors was conducted in group 1 and a double-row repair with four suture anchors in group 2. A total of ten intact contralateral shoulder joints was used as a control group. Biomechanical testing was performed immediately post-operatively and at four and eight weeks, and histological analysis at four and eight weeks. The mean load to failure in group 2 animals was greater than in group 1, but both groups remained lower than the control group at all intervals. Histological analysis showed similar healing properties at four and eight weeks in both groups, but a significantly larger number of healed tendon-bone interfaces were identified in group 2 than in group 1 at eight weeks (p < 0.012). The ultimate load to failure increased with the number of suture anchors used immediately post-operatively, and at four and eight weeks. The increased load to failure at eight weeks seemed to be related to the increase in the surface area of healed tendon-to-bone in the double-row repair group.     

The effect of locally applied vascular endothelial growth factor on meniscus healing: gross and histological findings

Introduction: Tears in the peripheral part of the menisci have a better healing potential than tears in the central part, because the central two-thirds of the menisci are avascular. We hypothesized that healing of meniscus tears in the avascular zone can be promoted by the local application of the angiogenic factor vascular endothelial growth factor (VEGF). Materials and methods: A tear was created in the avascular zone of the medial meniscus in 18 merino sheep. The tear was then repaired with an uncoated suture (group 1), a suture coated with PDLLA (group 2), and by a suture coated with PDLLA/VEGF (group 3). Results: After 6 weeks, we observed increased immunostaining for factor VIII in the VEGF-treated group 3. However, in this treatment group no meniscus healed completely. In the uncoated suture group and in the PDLLA-coated-suture group, partial healing was observed in three animals and complete healing in three animals, respectively. Conclusion: In this experiment the local application of VEGF via PDLLA-coated sutures did not promote meniscus healing. Growth factors might not always be a promising tool for tissue repair.     

关节镜下double-needle缝线修复混合型半月板撕裂

目的探讨关节镜下采用double-needle缝线修复混合型半月板撕裂的疗效。方法 2006年4月-2011年1月,关节镜下采用double-needle缝线修复22例单膝混合型半月板撕裂。男14例,女8例;年龄18～41岁,平均31.3岁。均为运动损伤。受伤至入院时间为2 d～4年,中位时间11个月。膝关节功能根据国际膝关节文献委员会(IKDC)评分标准为(42.5±15.2)分,Lysholm评分为(45.5±13.5)分,Tegner评分为(2.9±1.6)分。17例合并前交叉韧带损伤。结果术后切口均Ⅰ期愈合,无神经、血管损伤。患者均获随访,随访时间12～48个月,平均27.6个月。按照Barrett等的评定标准,19例半月板临床愈合,临床愈合率86%。末次随访时,患者膝关节活动度均恢复正常,IKDC评分为(77.1±8.9)分,Lysholm评分为(79.8±9.9)分,Tegner评分为(6.8±1.6)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下使用double-needle缝线由内向外修复混合型半月板撕裂固定牢固、疗效肯定。     

关节镜下修补半月板桶柄样撕裂的临床疗效分析

目的 探讨关节镜下修补半月板桶柄样撕裂的临床疗效.方法 关节镜下对61例63个桶柄样撕裂的半月板行修补手术,男38例,女23例;年龄16～47岁,平均27岁.内侧半月板后体部至前体部区域撕裂及外侧半月板胴肌腱前方区域撕裂采用标准的白内向外缝合技术;内侧半月板后角区域撕裂采用经两个后内侧入路的全关节内缝合技术;外侧半月板后角区域撕裂采用经前方关节镜入路的全关节内缝合技术.结果 61例63个半月板随访时间24～66个月,平均38个月.其中51例(53个半月板)行二次关节镜检.44个半月板(83%)完全愈合,5个半月板(9.4%)部分愈合,4个半月板(7.5%)不愈合.61例患者均进行临床评估,其中53例(87%)无临床症状,4例(6.5%)有部分临床症状,4例(6.5%)绞锁复发.总体评估:失效率为7.9%(5/63),成功率92.1%(包括完全愈合、部分愈合、无临床症状及部分临床症状者).结论 对于发生在红一红区或红一白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,可以获得约92%的成功率.     

Healing potential of experimental meniscal tears in the rabbit. Preliminary results

This study assessed the healing potential of longitudinal or transverse incisions in the peripheral, central, and inner rim regions of rabbit medial menisci. Longitudinal and transverse incisions were made in 48 male New Zealand white rabbits. The incisions were either repaired with sutures or left open. The effect of joint motion on repair was also evaluated. In one group, longitudinal incisions were made in the peripheral, central, and inner rim regions of the meniscus. Some of these incisions were sutured, whereas others were not repaired. In another group, transverse incisions were made in the meniscus, extending from the inner rim to the middle of the meniscus or to the peripheral attachment (radial tear). Again, the lesions were left open or repaired. The effect of joint motion on healing was assessed by immobilizing several knees from each group with Kirschner wires temporarily for ten weeks. Suture of the meniscus incision did not substantially affect the rate of healing. When the healing rates of menisci at the periphery, body, and rim were compared, incisions at the periphery healed significantly better than incisions at the meniscal body and central rim regions. K-wire immobilization did not substantially affect the rate of healing. The difference in healing with regard to the type of incision, either longitudinal or transverse, was not statistically significant.     

外侧半月板桶柄样撕裂联合缝合技术的应用

 目的 探讨关节镜下自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂的临床效果。方法 2004年11月至2009年11月,应用关节镜下联合缝 合技术修复外侧半月板桶柄样撕裂17例,男10例,女7例;年龄17~42岁,平均27.8岁。使用自内向外缝合技术对外侧半月板腘肌腱前方区域的撕裂进行缝合,使 用全内缝合技术对半月板后角区域的撕裂进行缝合。随访时进行体格检查、MR检查和二次关节镜探查,评估半月板愈合情况。结果 13例患者获得随访,随访时 间1~5年,平均23.7个月。随访期间症状消失者12例（92.3％,12/13）,绞锁复发1例（7.7％,1/13）。MRI证实半月板完全愈合11例（84.6％,11/13）,部分 愈合1例（7.7％,1/13）,不愈合1例（7.7％,1/13）。12例患者行二次关节镜探查,其中完全愈合10例（83.3％,10/12）,部分愈合1例（8.3％,1/12）, 未愈合1例（8.3％,1/12）。结论 应用自内向外联合全内缝合技术修复外侧半月板桶柄样撕裂,经术后MRI和二次关节镜探查证实半月板愈合率超过90%。     

Repair of three-month-old experimental meniscal lesions in rabbits

Repair of three-month-old longitudinal meniscal lesions in the central avascular portion of the knee joint was investigated in 18 rabbits. Three months after a longitudinal incision was made in the avascular portion of the meniscus, no healing was observed. At that time a full-thickness radial cut from the lesion to the joint capsule, without using synovial flaps or implants, was performed in ten of the 18 rabbits. Three months later, nine of the ten menisci had healed mainly with cartilaginous tissue, although the repaired areas were different from the normal fibrocartilage both histologically and at gross inspection. Synovitis with hyperplasia of the lining cells, which was present in all cases at the time of repair, may play an important role in the healing process.