Arthroscopic Arthrolysis for Arthrofibrosis of the Knee after Total Knee Replacement

background  

Arthrofibrosis is an uncommon but potentially debilitating complication following total knee replacement which can result in chronic pain and poor recovery of range of motion. The treatment of this condition remains difficult and controversial.     

小切口结合关节镜松解治疗膝关节僵直的疗效观察

目的研究关节镜辅助下小切口松解治疗膝关节僵直的临床效果。方法选择该院就诊的膝关节僵直患者19例,采用小切口结合关节镜松解术治疗膝关节僵直。结果术后1个月和末次随访时膝关节屈曲程度分别为90°～130°、95°～135°,较术前有明显改善,末次随访膝关节屈曲程度优于术后1个月。结论小切口结合关节镜下粘连松解术创伤小,韧带松解彻底,并发症发生率低,患者恢复快,临床效果好。     

Arthroscopic disc fixation to the condylar head. Use of resorbable pins for internal derangement of the temporomandibular joint (stage II–IV). Preliminary report of 34 joints

AimThe study describes the arthoscopic use of resorbable pins for the internal derangement of the temporomandibular joint with McCain's technique. Clinical and image features are reported retrospectively.MethodsTwenty-seven consecutive patients (34 joints) were included. Symptomatic internal derangement and anterior-medial disc displacement with or without reduction in magnetic resonance images (MRI) were diagnosed in all cases. Two resorbable pins (SmartNail) were placed in each joint employing arthroscopic surgery with a third portal for disc recapture and fixation to condylar head.Clinical data 24 months after surgery are reported (movements, pain score, clicking, laterodeviation, occlusal changes). In eight joints a MRI control was required between 1 and 2 years after surgery.ResultsVisual analogue scale values (0–100) decreased from 70.8 to 11.9 (p < 0.001) in the first control (week) and kept down after 24 months of follow-up (VAS: 4.8). Movements began to recover in 3 months and mouth opening increased from 34 mm to 43.2 mm 1 year after surgery (p < 0.001). Clicking, laterodeviation and contralateral excursions improvement were statistically significant (p < 0.001). MRI showed disc fixation to condyle head in closed and opened mouth.ConclusionDisc fixation to condylar head with resorbable pins is a safe and satisfactory procedure. Pain becomes drastically reduced and mandibular function recovers normal parameters in patients with internal derangement     

关节镜下盘状半月板成形术的临床观察

目的对65例关节镜下盘状半月板成形术的临床效果进行总结，分析影响手术效果的可能因素．探讨盘状半月板关节镜下手术的指征和方法。方法选择1996年9月～2003年9月65例盘状半月板患者．其中男性29例，女性36例，年龄8～46岁，平均年龄21、3岁。65例中合并半月板破裂者50例，包括分层撕裂23例，桶柄状撕裂16例，瓣状撕裂11例。手术方法：应用美国Stryker及德国蛇牌关节镜系统．用300镜观察，交替使用内侧和外侧切口置人不同角度篮钳和镜下电灼对半月板进行处理，保留半月板边缘6～8mm。结果65例患者术后均得到随访．随访时间6个月至24个月，平均14、3个月。手术后关节交锁症状全部消失。术后6个月根据Ikeuchi膝关节评分标准，优48例，良12例．一般5例。无术后功能差的病例。结论盘状半月板成形术可以最大程度地保留半月板的功能．延缓膝关节的退变，除Wisberg韧带型盘状半月板或合并严重撕裂者，应尽量采用此手术方法。应严格掌握该术式、适应证、禁忌证，避免影响手术效果的因素．