内侧半月板半脱位与膝关节损伤的MRI评价

目的：通过分析伴有内侧半月板半脱位的膝关节MRI影像学改变,探讨内侧半月板半脱位与膝关节损伤的关系。方法：回顾性分析77例内侧半月板半脱位的膝关节MRI表现。结果：①韧带损伤：26例前交叉韧带断裂（4例完全断裂、22例部分断裂）,与关节镜诊断完全符合率为88.8%;26例后交叉韧带断裂（3例完全断裂、23例部分断裂）,与关节镜诊断完全符合率为95%;17例内侧副韧带损伤（1例Ⅲ级损伤、13例Ⅱ级损伤、3例Ⅰ级损伤）;13例外侧副韧带损伤（8例Ⅱ级损伤,5例Ⅰ级损伤）;与关节镜诊断完全符合率为90%。②半月板损伤：73例内侧半月板损伤（50例Ⅲ度损伤、13例Ⅱ度损伤、10例Ⅰ度损伤）;30例外侧半月板损伤（10例Ⅲ度损伤、8例Ⅱ度损伤、12例Ⅰ度损伤）;MRI对半月板诊断结果与关节镜诊断完全符合率为90.5%;46例内侧半月板后根部损伤,与关节镜诊断完全符合率为92.21%。③软骨损伤：68例软骨损伤（1例4级损伤,21例3级损伤,46例2级损伤）;与关节镜诊断完全符合率为73%。④骨质增生：40例骨赘形成。结论：半月板半脱位是膝关节韧带损伤、半月板损伤、软骨损伤及骨质增生的重要间接征象。重视MRI内侧半月板半脱位,对于上述膝关节损伤的检出具有重要意义,能够有效防止膝关节骨性关节病的发生与发展。     

半月板损伤在核磁共振影像中的表现

目的观察膝关节运动损伤的影像学表现,探讨膝关节半月板损伤后核磁共振(MRI)影像变化特征对临床正确诊断意义。方法总结体育医院42例膝关节镜下治疗半月板损伤病例,对膝关节半月板损伤在影像学上的变化进行观察。结果肢体MRI影像学对膝关节半月板损伤,I度半月板内点状信号改变5例;II度半月板内线状高信号改变11例;III度半月板内线状高信号改变通达到关节面26例。结论MRI肢体核磁共振影像学的改变,可以提示诊断膝关节半月板损伤的程度,为临床治疗膝关节半月板损伤提供影像学参考。     

膝关节半月板损伤的磁共振分级诊断对采取关节镜手术的临床意义

目的:探讨膝关节半月板损伤的磁共振(MRI)分级诊断对采取关节镜手术治疗的临床指导意义。方法:回顾性分析2016年9月至2019年8月间在我院行MRI检查的97例(108个)膝关节半月板损伤患者资料。根据Fischer分级诊断标准分别对膝关节内、外侧半月板进行评估,并将半月板撕裂(III级损伤)细分为6个类型。对MRI诊断半月板撕裂的患者进行关节镜手术诊治,并将结果与MRI进行对照,评估MRI的诊断效能。结果:MRI诊断108个膝关节存在146侧半月板损伤,其中I级损伤43侧、II级损伤65侧、III级损伤38侧。MRI诊断38侧半月板撕裂中水平撕裂7侧、垂直撕裂8侧、斜行撕裂10侧、放射状撕裂2侧、纵形撕裂7侧、桶柄状撕裂4侧。关节镜确诊36侧半月板撕裂,其中水平撕裂5侧、垂直撕裂9侧、斜行撕裂12侧、放射状撕裂2侧、纵形撕裂5侧、桶柄状撕裂3侧。MRI诊断半月板撕裂的阳性预测值为94.74%,诊断撕裂类型的准确性为86.84%。结论:MRI诊断膝关节半月板损伤具有很高的价值,对半月板撕裂诊断阳性预测值高,对撕裂类型诊断准确率高,在筛选关节镜手术诊治患者中具有较高的指导意义。     

关节半月板损伤的低场强MRI诊断价值

目的探讨低场强MRI在膝关节半月板损伤中的诊断价值。方法回顾分析103例经临床或关节镜证实的膝关节半月板损伤患者，分析其在低场强MRI仪器上的表现及分级。结果103例患者半月板损伤数为165个，其中，Ⅰ级损伤48个，Ⅱ级损伤72个，Ⅲ级损伤45个。结论低场强MRI对膝关节半月板损伤具有很高的诊断价值，可以清晰显示半月板的形态、位置及信号变化，为临床治疗提供可靠依据，是目前诊断半月板损伤最好的方法。     

MRI在半月板损伤中的应用价值

目的:探讨膝关节半月板损伤的MRI诊断价值.方法:回顾性分析108例患者113例膝关节半月板损伤的MRI表现,并按Mink和Fischer方法进行分级.结果:113个膝关节中Ⅰ级损伤15个,Ⅱ级损伤29个,Ⅲ级损伤69个(经关节镜证实),其中14个为盘状半月板.结论:MRI对于膝关节半月板损伤的诊断具有很高的价值及临床意义,可以清晰地显示半月板的形态和位置及其信号的改变,为临床治疗提供可靠的依据,是目前诊断半月板损伤最好的检查方法.     

内侧半月板半脱位与后根部撕裂的相关性

目的 探讨膝关节内侧半月板半脱位对诊断后根部撕裂的价值。方法 回顾性分析经关节镜证实的120例内侧半月板撕裂患者的MRI图像,将其中60例后根部撕裂患者作为后根部撕裂组,其他撕裂的60例作为对照组,于MRI图像上测量半月板突出长度,将半月板突出长度≥3 mm定义为半月板半脱位,比较两组半月板半脱位的发生率。结果 后根部撕裂组中,合并半月板半脱位者56例(56/60,93.33%),对照组中合并半月板半脱位者13例(13/60,21.67%),差异有统计学意义(χ²=60.15,P<0.01)。内侧半月板半脱位提示后根部撕裂的敏感度、特异度及阳性似然比分别为81.16%(56/69)、92.16%(47/51)及10.35。结论 膝关节内侧半月板半脱位可用以提示后根部撕裂。     

膝关节内侧半月板突出与后根部损伤相关性的MRI分析

背景：半月板根部损伤是半月板突出的重要原因。近年来,国外有许多关于半月板根部损伤和半月板突出关系的研究报道,而国内暂无相关的报道。目的：探讨膝关节内侧半月板突出与内侧半月板后根部损伤的相关性。方法：回顾性分析84例具有膝关节内侧半月板突出征象患者的MRI及关节镜表现,将半月板突出长度≥3 mm或半月板突出长度/半月板最大径≥10%定义为严重突出,采用卡方检验分析两种测量方法下的内侧半月板突出与后根部损伤之间的相关性。结果与结论：MRI显示内侧半月板严重突出(半月板突出长度≥3 mm或半月板突出长度/半月板最大径≥10%)与关节镜检查显示半月板后根部损伤具有显著相关性(P <0.05),比值比及95%可信区间分别为25.04(3.07-204.44),6.96(1.38-35.19)。结果可见膝关节内侧半月板严重突出与内侧半月板后根部损伤密切相关,是半月板根部损伤的重要特征。     

半月板突出在膝骨性关节炎关节间隙狭窄中的作用

目的：探讨膝关节半月板突出在膝骨性关节炎(osteoarthritis，OA)的关节间隙狭窄中作用。方法：2003—01／2004—06对65骨关节炎膝及36正常自愿者膝在复旦大学附属华山医院骨科进行正侧位X射线检查和MRI扫描，根据X射线片进行内侧关节间隙Kellgren—Lawrence(K—L)分级，同时在MRI冠状面上评估内侧半月板突出程度。比较膝关节OA和正常膝关节半月板突出程度差异，并分析膝关节OA关节间隙狭窄和半月板突出的关系。结果：膝OA&;#183;组K—L分级：Ⅰ级狭窄13膝、Ⅱ级狭窄19膝、Ⅲ级狭窄22膝、Ⅳ级狭窄8膝，对照组均为0级；膝OA组半月板突出：正常3膝，轻度突出16膝，中度突出20膝，重度突出23膝。对照组半月板突出：正常11膝，轻度突出20膝，中度突出5膝。OA组内侧半月板突出程度与正常对照组比较差异有显著性意义(P&;lt;0．01)；骨关节炎组内不同K-L分级与内侧半月板突出程度有关系(r=0．461．P&;lt;0．01)。结论：内侧半月板突出是膝关节OA的一个重要特征，并且与关节间隙狭窄有关。     

MR检查对膝关节半月板损伤的诊断符合率分析

目的:分析在对膝关节半月板损伤患者进行检查的过程中使用磁共振成像(Magnetic Resonance,MR)在患者诊断过程中所起到的临床价值。方法:在2018年1月~2020年8月期间入院进行诊疗的膝关节半月板损伤患者中选取60例作为研究对象,对其分别进行关节镜检查与MR检查,在此过程中,以关节镜检查结果作为金标准,对于MR检查在临床应用过程中的诊断符合率进行对比分析。结果:数据显示,在患者半月板损伤程度方面,I级与II级损伤的患者比例为75.00%(45/60);III级损伤的患者比例为25.00%(15/60);在诊断准确率方面,通过与关节镜检查结果进行对比可得出,MR检查对于I级和II级半月板损伤的诊断符合率为97.78%(44/45),MR检查对于III级半月板损伤的诊断符合率为93.33%(14/15)。结论:在对膝关节半月板损伤患者进行检查的过程中,MR检查的诊断符合率相对较高,值得在临床过程中进行大量推广应用。     

半月板损伤的磁共振诊断与关节镜结果对照分析

【目的】进一步了解磁共振成像(MRI)对膝关节半月板损伤的诊断价值。【方法】对76(膝)例临床拟诊半月板损伤的MRI和关节镜检查结果作对照分析。【结果】76膝MRI确诊半月板损伤．关节镜发现半月板撕裂61个膝关节．与MRI诊断半月板Ⅲ级信号59个膝关节的结果相近。【结论】MRI对膝关节半月板损伤诊断极有价值，特别是半月板内Ⅲ级信号是诊断半月板撕裂的可靠征象。     

Rehabilitation following meniscal repair

It has become increasingly more evident that the meniscus plays an important role in contributing to knee joint longevity. Advances in surgical techniques by orthopaedic surgeons to repair traumatized menisci have led to better long term outcomes, decreasing the incidence of articular cartilage degeneration. Advances have also been made in rehabilitative techniques following meniscal repair. These techniques along with sound rehabilitation principles to include a criteria based progression have contributed to excellent outcomes and earlier return to function and sport. The role of the meniscus, recent advances in surgical repair and the current post-operative rehabilitation techniques employed by sports rehabilitation specialists today are discussed.     

关节镜下修复半月板损伤69例评价

目的 评价半月板快速缝合装置在关节镜下半月板损伤修复中的应用.方法 选择该院收治的NRI检查确认半月板撕裂患者69例.术中应用Fast-Fix缝合半月板撕裂.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 Fast-Fix半月板缝合系统适用于大多数类型半月板撕裂.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、IOY疗效评分显著高于术前(P＜0.01),疗效优良卒为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,是一种方便、有效的完全关节镜下半月板缝合装置.     

关节镜下治疗半月板囊肿

目的探讨膝关节镜下治疗半月板囊肿的手术方法及其疗效。方法该院2004年6月～2007年11月应用关节镜技术治疗14例膝关节半月板囊肿,6例行单纯囊肿切除,2例行囊肿切除同时行半月板全切术,6例行囊肿切除同时行半月板部分切除术,随访时间3～36个月,所有患者在关节镜手术治疗半月板囊肿前后均采用膝关节Lysholm评分对关节功能进行评分分析。结果术前Lysholm评分为(74.3&#177;23.5)分,术后提高至(95.3&#177;21.6)分,经t检验分析,P&lt;0.01,手术前后Lysholm评分差异有显著性。术后患者膝关节疼痛及肿胀症状明显减轻,活动度恢复正常,无囊肿复发,无感染及血管神经损伤等并发症。结论膝关节镜下治疗半月板囊肿,手术创伤小,能较好地保留半月板功能和减少膝关节骨关节炎的发生,是治疗半月板囊肿的首选方法。     

Advances in meniscal tissue engineering

Injuries and lesions to the meniscal cartilage of the knee joint are common. As a result of its limited regenerative capacity, early degenerative changes to the articular surface frequently occur, resulting in pain and poor function. Currently available surgical interventions include repair of tears, and partial and total meniscectomy but the results are inconsistent and often poor. Interest in the field of meniscal tissue engineering with the possibilities of better treatment outcomes has grown in recent times. Current research has focused on the use of mesenchymal stem cells, fibrochondrocytes, meniscal derived cells and fibroblast-like synoviocytes in tissue engineering. Mesenchymal stem cells are multipotent cells that have been identified in a number of tissues including bone marrow and synovium. Current research is aimed at defining the correct combination of cytokines and growth factors necessary to induce specific tissue formation and includes transforming growth factor-β (TGF-β), Platelet Derived Growth Factor (PDGF) and Fibroblast Growth Factor 2 (FGF2). Scaffolds provide mechanical stability and integrity, and supply a template for three-dimensional organization of the developing tissue. A number of experimental and animal models have been used to investigate the ideal scaffolds for meniscal tissue engineering. The ideal scaffold for meniscal tissue engineering has not been identified but biodegradable scaffolds have shown the most promising results. In addition to poly-glycolic acid (PGA) and poly-lactic acid (PLLA) scaffolds, new synthetic hydrogels and collagen sponges are also being explored. There are two synthetic meniscal implants currently in clinical use and there are a number of clinical trials in the literature with good short- and medium-term results. Both products are indicated for segmental tissue loss and not for complete meniscal replacement. The long-term results of these implants are unknown and we wait to see whether they will be proved to have benefits in delaying arthritic change and chondral damage.     

关节镜治疗半月板损伤

目的探讨关节镜手术治疗膝关节半月板损伤的临床疗效。方法对38例46个关节(左膝14例,右膝16例,双膝8例)半月板损伤的发生原因、损伤部位、损伤类型及在关节镜下手术治疗进行临床分析。结果38例术后随访6￣18个月,优13例14个关节,良19例22个关节,优良率占78.26%,可6例10个关节,占21.74%。结论半月板先天发育不良或半月板退变与膝关节应力变化是半月板损伤的成因;明确半月板损伤的部位和类型是手术治疗的前提;关节镜治疗半月板损伤的优势在于关节镜检查的准确性和关节镜手术的微创性;半月板损伤早作关节镜手术疗效好,晚做因关节继发病变影响疗效,只能改善关节疼痛症状,关节功能改善不够理想。     

关节镜下内减压术治疗膝关节半月板囊肿

目的 探讨膝关节镜下半月板切除或缝合及囊肿内减压术治疗半月板囊肿的疗效.方法 回顾性分析2005年12月～2010年7月采用膝关节镜治疗的23例外侧半月板囊肿患者.术中行半月板部分或全部切除及缝合处理半月板撕裂,使用射频及刨削刀扩大囊肿内口使其与关节腔相通,清理囊肿内容物及分隔.术后指导患者行患肢功能锻炼,门诊随访.术前术后进行膝关节Lysholm功能评分对比.结果 所有患者均可见半月板不同程度撕裂.全部病例获随访,平均随访时间202个月.术后膝关节疼痛症状消失或明显缓解,关节交锁和弹响症状消失,随访期内无囊肿复发病例.膝关节Lysholm评分术前为(59.3±12.2)分,术后为(81.4±10.4)分,差异有显著性(t=-10.342,P =0.002).结论 膝关节镜下半月板切除或缝合加内减压术治疗半月板囊创伤小、康复快,可获得确切的临床疗效.     

Augmentation techniques for isolated meniscal tears

Meniscal tears are relatively common injuries sustained by athletes and non-athletes alike and have far reaching functional and financial implications. Studies have clearly demonstrated the important biomechanical role played by the meniscus. Long-term follow-up studies of post-menisectomy patients show a predisposition toward the development of degenerative arthritic changes. As such, substantial efforts have been made by researchers and clinicians to understand the cellular and molecular basis of meniscal healing. Proinflammatory cytokines have been shown to have a catabolic effect on meniscal healing. In vitro and some limited in vivo studies have shown a proliferative and anabolic response to various growth factors. Surgical techniques that have been developed to stimulate a healing response include mechanical abrasion, fibrin clot application, growth factor application, and attempts at meniscal neovascularization. This article discusses various augmentation techniques for meniscal repair and reviews the current literature with regard to fibrin clot, platelet rich plasma, proinflammatory cytokines, and application of growth factors.     

Gapping phenomenon of longitudinal meniscal tears

OBJECTIVE: To investigate the gapping behaviour of longitudinal meniscal tears. DESIGN: The gap size of longitudinal meniscal tears was measured in porcine knee joints under various joint loading conditions. BACKGROUND: Many meniscal fixation implants have low pull out forces. However, it is unknown if these forces are less than the forces the implants must resist in vivo. It is also unknown if gapping occurs in longitudinally torn menisci and what joint loads induce gapping. METHODS: Longitudinal tears were set in the medial menisci of eight porcine knee joints. To observe the tears an opaque placeholder of the same shape as the original articular surface replaced the medial tibial plateau. The knees were exposed to flexion-extension cycles in a loading and motion simulator under 30 and 200 N axial joint load without external moments, under tibial rotation moments, varus or valgus moments, and combined moments. For each load condition the maximum gap of the tear was registered. RESULTS: Maximum gapping (1.59 mm, SD 0.47) occurred in the 3 cm tear at 200 N axial joint load under the combination of a valgus and external rotation moment. An internal tibial rotation moment produced the smallest gaps in tears of any length and at any axial joint load. CONCLUSIONS: The maximum gap size found in this study and the previously published pull out stiffnesses of meniscal fixation implants reveal maximum forces on the implant in vivo of only 8.4 N. This explains why meniscal tears fixed with implants of low pull out strength can heal. RELEVANCE: The current study shows that moderate joint loads only lead to small gaps of meniscal tears. Clinically, this means that fixation implants of low pull out strength are not in danger of failure in a normal rehabilitation regimen.     

组织工程学在半月板修复置换中的应用

半月板大部或次全切除后并发膝关节骨性关节炎是导致膝关节病废的主要原因之一。采用组织工程学方法修复损伤的半月板组织,在几个重要环节上取得了较明显的进展,利用胶原构成的支架,加上自身的软骨细胞,此种支架密度低,有利于血管长入及与周边组织愈合。种子细胞以自身纤维软骨细胞最为理想,能够形成几何形状的半月板组织,但远期观察半月板组织的生物性能,尚缺乏足够的时间,有待于从基础到临床获得较为可靠的数据来证明组织工程学修复损伤半月板组织的作用。