应用关节镜清理和透明质酸钠注射治疗膝关节骨关节炎

目的：比较2例治疗膝关节骨关节炎方法的效果。方法：2组病人分别采用关节镜清理和透明质酸钠注射治疗膝关节骨关节炎，结果：术后随访2年以上，根据关节疼痛，积液肿胀，关节活动度，行走功能四个项目及综合评价。关节镜组随访结果，半年－1年，优良率为96．2％，1－2年，优良率84．6％，2年以上优良率为73％，透明质酸钠组随访结果：半年－1年，优良率为94．9％，1－2年，优良率86．4％，2年以上优良率为74．6％，。结论：关节镜清理和透明质酸钠注射治疗膝关节炎2种方法都有一定的效果，2组之间无明显差别。     

关节镜清理术治疗膝骨关节炎的围手术期护理

目的探讨在局麻关节镜下关节清理术治疗膝骨关节炎的围手术期护理。方法我院自2002年2月至2007年7月采用局麻关节镜下关节清理术治疗膝骨关节炎共63例（77个膝关节）。术前制定系统的护理计划。对患者的心理和身体状况进行充分评估．教会患者手术配合要领及功能锻炼的方法和注意事项。63例全部得到随访，随访时间6个月～4年，平均2．1年，随访内容包括JOA膝关节功能评分以及患者对手术的满意度。结果JOA膝关节功能评分由术前41分增加到术后78分。患者主观评定优40．2％．良36．3％，可15．6％．差7．8％，优良率为76．5％。结论科学的护理方法有助于关节镜下治疗膝骨关节炎的手术效果，提高患者术后膝关节功能恢复的满意度。     

膝骨关节炎的关节镜清理术及围手术期处理

目的探讨关节镜清理术治疗膝骨关节炎的疗效。方法回顾分析2004年7月-2007年7月采用关节镜下清理术治疗并获得随访膝关节骨关节炎患者96例（102膝）,术前给予一定心理治疗,术后指导进行功能康复锻炼。术后进行4～24个月随访（平均随访17个月）,随访3～12个月72例,随访13～24个月24例。结果随访期3～12个月者优良率76.3%,随访期13～24个月者优良率65.1%。结论关节镜清理术治疗膝骨关节炎有肯定的近期疗效,适当围手术期处理有利于提高疗效。     

关节镜清理术治疗老年性膝骨关节炎

目的探讨关节镜对老年性膝骨关节炎的诊断价值及治疗效果。方法自2001年10月至2003年3月使用关节镜清理治疗膝关节骨关节炎患者37例,按照Lysholm膝关节功能评分,术前膝关节功能评分为(53.6±7.3)分。随访3～15个月,平均9个月。结果本组37例病人经关节镜检查均证实有骨关节炎存在,术前摄片,21例出现病理改变,16例未发现病理改变。本组病人术后3个月症状缓解明显,Lysholm膝关节功能评分平均提高到(92.7±1.5)分,统计学分析显示术后与术前评分相比差异有显著性意义。结论关节镜清理术可有效治疗膝骨关节炎;膝关节镜术可早期诊断膝骨关节炎;其损伤小、疗效好、并发症少,可重复手术治疗,能早期恢复关节的功能。     

关节镜诊断和治疗膝关节骨关节炎

自１９９０年７月￣１９９５年７月，作者对７９例（９１膝）膝关节骨关节炎（ＯＡ）患者进行关节镜检查及镜下清理术。镜检结果：２３例（２７膝）获得早期诊断，关节镜分级与临床表现呈正相关，与Ｘ线片改变程度的符合率较低（４７．１％）。随访２￣５年，平均３．９年。术后综合评估：１￣２年，优良率７７．２％，２年以上优良率６０．８％。软骨退变程度与疗效关系：术后１￣２年优良率：软骨Ｉ度退变１００％、Ⅱ度７１．４％     

镜下清理配合透明质酸钠注射治疗膝骨关节炎

目的探讨关节镜下清理配合关节腔内注射透明质酸钠治疗膝关节骨关节炎的临床疗效。方法自2003年9月至2005年6月,对26例32膝膝骨关节炎病人行关节镜下清理术配合关节腔注射透明质酸钠治疗。采用Yang的膝关节疼痛及功能评分方法,观察治疗前后关节疼痛与关节功能改善程度。结果所有病例随访6-18个月,平均12.5个月。疗效优11例15膝（46.9%）,良8例10膝（31.3%）,可6例6膝（18.7%）,差1例1膝（3.1%）。优良率为78.2%,取得了满意的疗效。26例中无手术并发症发生。结论关节镜下清理并用透明质酸钠注射治疗早、中期膝骨关节炎有明显疗效。     

关节镜清理术治疗膝关节骨性关节炎

目的：探讨关节镜下行关节清理治疗膝关节骨性关节炎的疗效。方法：对32例(44膝)骨性关节炎患者，行膝关节镜检查，并在关节镜下行清理术。术后3个月及1年后复查，随访膝关节疼痛、肿胀及活动功能的改善情况。结果：治疗后膝关节疼痛缓解、肿胀减轻、功能改善。术后3个月复查，优良率达85％：经1年以上随访，优良率为72％，无复发及并发症。结论：关节镜下行关节清理术治疗膝关节骨性关节炎是一种疗效好且简便的方法。     

关节镜下清理膝关节骨性关节炎的疗效观察

目的：探讨关节镜清理术治疗伴有游离体或半月板交锁的膝关节骨性关节炎的疗效。方法将符合条件的87例伴有游离体或半月板交锁的膝关节骨性关节炎患者随机分为两组, A组45例患者（56膝）,予以关节镜下清理术治疗,摘除游离体,解除半月板交锁,B组42例患者（51膝）,给予保守治疗,规律治疗6个月,观察两组患者治疗后的效果。结果 A组经关节镜治疗后6个月优良率为89．29％,B组经保守治疗6个月后优良率为64．71％。两组相比较差异有统计学意义（P＜0．01）。A 组患者术后随访2年,术后6个月、1年、2年的优良率分别为89．29％,76．79％和69．64％,术后2年疗效显著低于6个月（χ2＝1．439,P＝0．04）。结论关节镜清理术治疗伴有游离体或半月板交锁的膝关节骨关节炎疗效要优于药物保守治疗,但其疗效有可能随着时间的延长而降低。     

胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎

目的 探讨采用胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎的疗效。方法 对22例膝内侧单间室骨关节炎患者先行关节镜下清理术,再予以胫骨内侧高位截骨。采用Lysholm评分评价疗效。结果 患者均获得1年随访。切口均一期愈合,术后8周胫骨截骨处基本愈合。术后半年及1年均采用Lysholm膝关节功能评分评价疗效:术后半年优19例,良2例,可1例,优良率21/22;术后1年优18例,良2例,可2例,优良率20/22。结论 胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎可以有效改善患者膝关节症状,是一种简单、安全的手术方法。     

关节镜手术治疗膝骨性关节炎的体会

[目的]探讨膝关节镜下有限清理联合透明质酸钠注射治疗骨性关节炎的疗效。[方法]本院2003年9月～2004年10期间治疗的45例（52膝），采用关节镜下清理术联合透明质酸钠注射治疗，术后早期功能锻炼。[结果]参照Lyscholm评价标准，经1a随访，优良率93．3％，未出现感染、血肿、血管及神经损伤等并发症。[结论]关节镜术下有限清理联合透明质酸钠注射治疗膝骨关节炎，术后疗效满意，笔者认为在把握好手术适应证的基础上，该方法应该作为膝骨性关节炎的首选治疗方法。     

Debridement arthroscopy. 10-year followup.

The treatment of osteoarthritis of the knee is a difficult problem. In the senior author's opinion, nonaggressive arthroscopic debridement of the knee is an effective procedure to relieve pain and restore function in patients with osteoarthritis of the knee. A subjective telephone interview of patients done 10 or more years after arthroscopic debridement evaluated the long term results of this treatment in patients with osteoarthritis of the knee. The patients all were candidates for total knee replacement who selected arthroscopy as a temporizing procedure. Of the 191 knees in patients undergoing arthroscopic debridement, 77 patients (91 knees) were contacted for followup. Sixty-seven percent of the 91 knees did not have total knee arthroplasty at an average of 13.2 years followup. The Tegner activity score averaged 3.5 and patient satisfaction averaged 8.6 on a 0 to 10 scale. Twenty-one patients (30 knees) or (33%) had total knee arthroplasty at an average of 6.7 years. Seven of these had total knee arthroplasty within 2 years of arthroscopic debridement. Six of these seven knees had Outerbridge Grade 4 articular cartilage changes and clinically significant meniscus tears. Seven of the 19 knees (37%) with Outerbridge Grade 4 changes in 80% of one knee compartment did not require total knee arthroplasty after greater than 10 year followup. The difficulties in long term followup in this patient population is evident, yet the number of patients who had a functional lifestyle after arthroscopic debridement was notable.     

Arthroscopic debridement for grade III and IV chondromalacia of the knee in patients older than 60 years

Arthroscopic debridement has been used to treat patients with degenerative knee osteoarthritis, although there is sometimes conflicting evidence documenting its efficacy. This study evaluates the success of arthroscopic debridement in elderly patients with grade III and IV chondromalacia of the knee as measured by patient satisfaction and the need for additional surgery. From December 1998 to August 2001, a total of 102 consecutive cases of knee arthroscopy in 99 patients > 60 years were performed. Average follow-up was 34 months (range: 7-104 months). Patients were asked about their satisfaction using a visual analog scale, and the presence of meniscal lesions during arthroscopy and the treatment for these lesions were evaluated. Knees also were assessed for articular surface degeneration using Outerbridge's classification for chondromalacia. The need for and type of additional surgery was evaluated. During arthroscopy, meniscal lesions requiring a partial meniscectomy were found in 95 knees. Chondromalacia was found in 92 knees; 53 knees had grade I or II chondromalacia and 39 knees had grade III or IV chondromalacia. Additional surgery was performed in 17 knees. Mean patient satisfaction score was 73 (range: 50-100) in the 39 knees with grade III or IV chondromalacia after arthroscopic debridement was performed. These findings suggest arthroscopic debridement in elderly patients has a place in the treatment algorithm for grade III or IV chondromalacia of the knee.     

关节镜下清理和钻孔治疗膝关节软骨退变的疗效分析

目的探讨关节镜下清理和钻孔治疗膝关节软骨退变的临床疗效。方法 2009年1月至2013年2月,87例膝关节软骨退变患者随机分为两组,A组含45例(56侧),予关节镜下清理术治疗;B组含42例(51侧),行关节镜下清理+软骨下骨钻孔术,术后予对症治疗。观察两组患者治疗后的效果。结果 A组治疗后6个月时优良率为64.29%,B组6个月后优良率为84.31%,差异有统计学意义(P<0.01)。两组患者术后均随访2年,B组术后6个月、1年和2年的优良率分别为89.29%、80.36%和75.00%,术后2年时的疗效显著低于6个月时(P=0.04)。结论关节镜清理+钻孔术治疗膝关节软骨退变疗效优于单纯关节镜清理术,但其疗效随时间延长而降低。     

关节镜下清理术结合散瘀通络汤内服治疗膝骨关节炎的疗效分析

目的:探讨关节镜下清理术结合散瘀通络汤内服治疗膝关节骨性关节炎的临床疗效。方法:回顾分析2013年6月至2016年5月为65例膝骨关节病患者行关节镜清理术的临床资料,其中观察组33例结合散瘀通络汤内服,对照组32例行单纯关节镜清理术,并对比治疗结束后6个月的随访疗效。结果:治疗结束后6个月,观察组总有效率为97%,对照组为75%,观察组的疗效优于对照组(P<0.05)。结论:采用散瘀通络汤结合关节镜下清理术综合治疗的疗效优于单纯使用关节镜下清理术,值得推广。     

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9~79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3~24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。     

Role of arthroscopy in osteoarthritis of the knee.

We compared arthroscopic partial menisectomy with limited debridement versus arthroscopic abrasion arthroplasty in patients with osteoarthritis. Group I consisted of 131 knees in 131 patients treated by partial meniscectomy and debridement of loose articular cartilage or removal of loose bodies. All patients had grade 3 or 4 chondromalacia in the affected compartment. The patients were followed for a mean of 3 +/- 1 years. Group II consisted of 28 knees in 28 patients treated by debridement with abrasion arthroplasty of exposed bone. The mean age of this group of patients was 63 years and they were followed for a mean of 3.8 years. The Group I patients noted 80% improvement by 1 year but this fell to 67% by 5 years after meniscectomy. Overall, 104 were improved, 16 unchanged, and 15 worse at the time of last evaluation compared to their preoperative status. In the Group II patients, 11 were improved, 8 unchanged, and 9 worse. Fifty percent of Group II subsequently underwent a total knee arthroplasty for salvage at a mean of 3 years following the abrasion procedure. Abrasion arthroplasty appears to offer little benefit over partial meniscectomy and debridement in the degenerative knee. Results of abrasion arthroplasty are unpredictable.     

Arthroscopic medial release for medial compartment osteoarthritis of the knee: the result of a single surgeon series with a minimum follow-up of four years

The outcome of arthroscopic medial release of 255 knees in 173 patients for varying grades of osteoarthritis involving the medial compartment is reported. All operations were performed by a single surgeon between January 2001 and May 2003. The Knee Society score for pain and the patient's subjective satisfaction were used for the outcome evaluation. Overall, satisfactory outcome was reported for 197 knees (77.3%) and the mean Knee Society score for pain improved from 17.6 (95% confidence interval, 16.7 to 18.5), pre-operatively to 39.4 (95% confidence interval, 37.9 to 41.1) (p < 0.001). There were minor manageable complications of persistent effusion in 16 knees and prolonged wound discomfort in 11. In total, 15 of the 21 knees with poor results were converted to total knee replacements and two other patients (three knees) were offered this option after a mean period of 16 months. Based on these observations arthroscopic medial release is an effective treatment for osteoarthritis of the medial compartment of the knee joint and can be expected to reduce the pain in the majority of patients for at least four years post-operatively.     

膝关节清理术后注射透明质酸钠治疗膝骨关节炎

目的观察膝关节清理术后注射透明质酸钠治疗膝骨关节炎的疗效。方法在膝关节清理术后每月向关节腔内注射２４９ｍｍｏｌ·Ｌ－１（１％）透明质酸钠２５ｍｌ治疗膝骨关节炎３０例（３３膝）。结果术后平均随访２年,优２３膝、良７膝、差３膝。结论膝关节清理术后注射透明质酸钠治疗膝骨关节炎,可取得满意效果。     

关节镜下髌骨外侧支持带松解加清理术治疗髌骨外侧高压综合征

目的探讨关节镜下髌骨外侧支持带松解加清理术治疗髌骨外侧高压综合征的方法及疗效。方法自2004年9月至2008年5月对96例髌骨外侧高压综合征患者行关节镜下联骨外侧支持带松解加清理术,男34例,女62例;年龄51～65岁,平均58岁。左膝46例,右膝50例。术后积极进行康复训练。采用Lysholm膝关节功能评分评价疗效。结果术后随访时间14～36个月,平均25个月。术后1个月所有患者膝关节疼痛明显减轻或消失,1年后74例疼痛基本消失。Lysholm评分,优64例,良18例,可10例,差4例,优良率85．4％,患者主观满意率为95．8％。结论关节镜下松解髌外侧支持带治疗髌骨外侧高压综合征具有创伤小、康复快等优点,并可同时在关节镜下进行关节清理术,对髌股疼痛伴有髌骨向外侧倾斜且关节软骨退变较轻的病例,疗效良好。术后采取积极的康复训练会明显提高疗效。