关节镜手术治疗半月板损伤的近期疗效

目的 探讨膝关节镜下治疗半月板损伤的近期疗效。方法 总结116例患者诊断及治疗情况，分析其近期治疗效果。结果 术后92例患者获得随访，平均随访时间12个月，疗效评价：优57例，良29例，可4例，差2例，优良率为93．5％。结论 镜下半月板手术创伤小、出血少、术后恢复快且能最大程度地保留半月板，宜为半月板损伤首选的治疗方法。     

关节镜手术治疗半月板损伤的疗效观察

目的探讨关节镜手术治疗半月板损伤的效果。方法对均36例半月板损伤患者实施关节镜下手术,其中半月板缝合修整术12例半月板部分切除15例,次全切除7例,全切除2例。结果术后均未发生血栓性静脉炎、股四头肌的萎缩等严重并发症。均获随访6个月~4 a,平均2.06 a。依据Ikeuchi标准评价膝关节功能恢复情况:优良率80.56%,(29/36)。结论关节镜下治疗膝关节半月板损伤手术创伤小,术后功能恢复满意,值得临床应用。     

关节镜下手术治疗盘状半月板损伤

目的探讨盘状半月板损伤关节镜下手术治疗效果。方法对38例盘状半月板损伤患者在关节镜下行部分切除成形26例,次全切除8例,完全切除4例。结果38例随访6-18个月,疗效按Ikeuchi评分标准进行评定,优27例,良7例,中4例。结论关节镜下手术治疗盘状半月板损伤可以获得良好的效果。     

关节镜半月板成形术治疗半月板损伤109例

目的 探讨关节镜下半月板成形术治疗半月板损伤的临床疗效.方法 109例半月板损伤患者(138膝,无合并关节内韧带损伤)在关节镜下行半月板成形术,Lysholm膝关节评分系统评价治疗效果并作手术前后统计学分析.术后3、6、12、15、18个月定期随访.结果 术后膝关节功能优93例,良12例,可3例,差1例,优良率96.33%.按Lysholm膝关节功能评分标准:术前为39～48(46.7±3.6)分,术后18个月时为76～96(82.2±5.3)分,手术前后评分比较差异有统计学意义(P＜0.01).结论 关节镜下半月板成形术治疗半月板损伤是一种安全有效的方法.     

关节镜下膝关节半月板损伤的治疗

目的探讨依照关节镜下膝关节半月板损伤分型治疗损伤半月板的疗效。方法按关节镜下膝关节半月板损伤的分型采用不同方法治疗膝半月板损伤患者71例74膝。结果 71例均获随访,时间6个月～2年。疗效评定：优59例61膝,良10例11膝,尚可2例2膝,无差病例。结论关节镜下仔细的检查分型是对关节镜治疗半月板损伤有指导意义的重要方法,可减少对半月板组织结构的破坏,疗效较好。     

经关节镜半月板部分切除治疗半月板无血管区损伤

目的 分析关节镜下半月板部分切除治疗半月板无血管区损伤的手术疗效，提出较适宜的手术时机。方法 随访276例(侧)半月板无血管区损伤关节镜下部分切除的患者，从手术时间、镜下部分切除术后疗效进行分析、比较。结果 半月板损伤后15d～2个月组行半月板部分切除术后优良率达79％；2～4年组治疗术后优良率为57．2％。结论 半月板损伤应早期诊断、早期治疗；早期关节镜下部分切除无血管区损伤半月板的疗效明显优于晚期手术治疗。     

关节镜手术治疗前交叉韧带并半月板损伤

目的 探讨关节镜手术治疗前交叉韧带(ACL)合并半月板损伤的方法及疗效.方法 关节镜下对135例ACL合并半月板损伤患者行ACL重建,同时行半月板修复或半月板修整.结果 患者均获随访,时间3～12个月,术后未出现关节粘连、血管神经损伤等并发症,半月板修整患者均无交锁且回旋挤压试验阴性.半月板修复患者3个月时随访,回旋挤压试验阳性1例;12个月时随访,回旋挤压试验阳性3例,交锁1例,两者都有1例.Lysholm评分:手术前为(46.3±6.2)分,术后6个月为(73.4±7.6)分,术后12个月为(87.8±8.2)分,术前与术后比较差异有统计学意义(P<0.01).结论 ACL与半月板常同时损伤,手术前应作好ACL重建及半月板修复或修整准备,关节镜同期治疗ACL并半月板损伤可取得较好疗效.     

关节镜下治疗半月板损伤的临床疗效分析

目的探讨关节镜治疗膝关节半月板损伤的方法以及疗效。方法应用膝关节镜对174例半月板损伤进行诊治。结果平均随访18个月,Lysholm-II评分术前为(51±2.6)分,术后(89.0±2.5)分,较术前提高(38.0±3.8)分(P0.01),其优良率为94.8%。结论关节镜下治疗半月板损伤具有创伤小、疼痛轻、术后恢复快、切口小等优点,诊断和治疗可同步进行,值得推广应用。     

关节镜微创手术治疗膝关节半月板损伤

目的探讨关节镜微创手术治疗膝关节半月板损伤的方法及疗效。方法回顾性分析应用膝关节镜诊治膝关节半月板损伤患者63例,施行半月板部分切除成形术16例,部分切除及囊肿切除3例,盘状半月板部分切除成形术4例,半月板全切除5例,半月板破裂缝合35例（包括合并有前十字韧带损伤3例,前十字韧带和内侧副韧带同时损伤1例,后十字韧带损伤1例）。采用Lysholm评分评定膝关节功能,术前Lysholm评分平均为（48.6±6.2）分。结果全部获得随访,随访时间为1～23个月,平均10个月。术后Lysholm评分平均为（90.5±5.8）分,较术前有显著提高,差异有统计学意义（t=4.12,P〈0.01）。结论关节镜微创手术治疗半月板损伤,综合应用缝合技术可达到最大限度保留半月板,创伤小、恢复快、疗效佳,并可同时处理其他病变。     

关节镜下两种手术方式治疗盘状半月板损伤的临床疗效对比

目的对比关节镜下半月板成形术及半月板全切除术治疗盘状半月板损伤的临床效果。 方法选取2014年8月至2016年8月广东医科大学附属医院收治半月板损伤患者68例为研究对象,患者确诊为盘状半月板损伤不伴韧带松弛或损伤,单侧膝关节发病,无关节畸形及严重骨质疏松。依据术式的不同将其分为A组(25例)和B组(43例),A组施行关节镜下全切除术,B组施行关节镜下半月板成形术。采用配对t检验和χ²检验比较两组患者Lysholm评分情况、术后3个月美国特种外科医院(HSS)评分、MRI复查情况和并发症发生情况。 结果两组患者术后切口均Ⅰ级愈合。A组半月板的优良率(64.00%)显著低于B组(79.06%),差异有统计学意义(χ²＝12.84,P<0.05)。术前两组患者Lysholm评分比较,差异无统计学意义(P>0.05);术后3个月,A组和B组患者的Lysholm评分[(77±16)分、(93±19)分]均较术前[(56±12)分、(66±14)分]显著提高(t＝4.541、5.231,P<0.05),且B组的Lysholm评分显著高于A组,差异有统计学意义(t＝5.132,P<0.01)。B组的术后3个月膝关节评分(HSS)总分(88.0±2.3)分均明显高于对照组的(71.2±2.0)分,差异有统计学意义(t＝3.707,P<0.05),但两组患者疼痛、肌力评分比较,差异无统计学意义(P>0.05)。MRI评估显示B组的完全愈合率高于A组,且A组发现2例有关节退行性病变。 结论半月板成形术及全切除术术式均具有良好的近期疗效。但半月板成形术能最大程度地恢复膝关节功能,减少膝关节退行性病变等并发症的发生,疗效优于全切除术。     

Two to nineteen years follow-up of arthroscopic meniscal repair using the outside-in technique: a retrospective study

PURPOSE: To perform a long-term follow-up evaluation of the outside-in technique of arthroscopic meniscal repair. TYPE OF STUDY: Retrospective study. METHODS: Between the years 1986 and 2002, 93 cases of arthroscopic meniscal repair using the outside-in technique have been operated by the senior author (F.L.). Forty-one patients were available for the follow-up evaluation with a mean follow-up of 11.71 years. The International Knee Documentation Committee (IKDC), the modified Lysholm score, the SF-36 (short form 36) health survey score, a visual analogue scale (VAS) for assessment of patients' satisfaction and another VAS for assessment of patients' pain were used retrospectively to evaluate the patients. We also used the Kellgren and Lawrence (K/L) classification of osteoarthritis to evaluate the preoperative X-rays and the X-rays done at the time of the follow-up evaluation. Failure was defined as having a meniscectomy procedure post-operatively. Results: From the 93 patients, 52 could not be retrieved for the follow-up evaluation, while 41 were available for it; 36 patients were clinically successful and 5 were considered as failure. Thirty-six patients were classified as grade "A" in the objective IKDC score, mean modified Lysholm score was 87.29 (SD 16.43), while mean SF-36 score was 85.73 (SD 14.17). The results of the VAS for operation satisfaction ranging from -10 to +10 revealed that the mean of the answers was 8.05 (SD 2.99). The results of the VAS for pain ranging from 0 to 10 revealed that the mean of the patients' pain at the time of the follow-up evaluation was 1.8 (SD 2.42). Twenty out of 24 (only 24 preoperative X-rays were available) were classified as having no osteoarthritis pre-operatively, whereas only 12 out of the 41 patients were classified as having no osteoarthritis (normal) at the time of the follow-up evaluation according to the K/L classification which indicates progression of osteoarthritis. No complications related to the outside-in arthroscopic meniscal repair procedure were reported. CONCLUSION: We conclude that arthroscopic meniscal repair using the outside-in technique is a safe surgical procedure with a good clinical outcome.     

A retrospective analysis of risk factors for meniscal co-morbidities in anterior cruciate ligament injuries

Background:

The association of meniscal cartilage injury with anterior cruciate ligament (ACL) injury is well documented in literature. The aim of this study was to examine the relative risk factors for meniscal pathology at the time of arthroscopic ACL reconstruction.

Materials and Methods:

A review of the case records including both in-patient and out-patient charts of all patients who underwent arthroscopic ACL reconstruction during the preceding 3 years was performed by either of the authors. The relative incidences of associated meniscal pathologies were analyzed in correlation with age, side of injury, time to surgery, mode of injury, and gender as the risk factors. Statistical analysis was performed to obtain individual data correlation.

Results:

A total of 192 patients underwent ACL reconstruction during the 3-year time frame. Of these, complete data sets were available for 129 patients. Analysis revealed that the only factor that was statistically significant in raising the risk of meniscal pathology was the time to surgery (P = 0.001). There was a significant increase in medial, lateral, and both meniscal tears noted in cases operated beyond 24 weeks. Further, the incidence of medial meniscal tears as well as lateral meniscal tears increased with delay in presentation for surgery (P = 0.004). Mode of injury, age at presentation, sex, and side were not significantly associated with an increased incidence of meniscal pathology.

Conclusion:

The single factor that significantly affects incidence of meniscal co-morbidity in ACL injury is the delay in presentation (i.e. the time to surgery). The incidence of lateral meniscal tears as well as medial meniscal tears increased with delay in surgery. This should guide us toward recommending all patients irrespective of age, gender, or mode of injury to undergo early reconstruction, thereby reducing the likelihood of developing meniscal pathology.     

Arthroscopic partial meniscectomy

Meniscal tears are among the most common problems surgically addressed in the practice of knee surgery. Arthroscopic partial meniscectomy has become the standard in managing meniscal damage not suitable for repair or allograft replacement. Current techniques involve low morbidity, rapid rehabilitation, and early return to functional activities. However, recent studies suggest that the optimistic early results of arthroscopic partial meniscectomy may deteriorate over time.     

关节镜下经膝半月板滑膜缘入路治疗半月板囊肿24例

目的探讨关节镜下经膝半月板滑膜缘入路行半月板囊肿切除术的效果。方法对24例膝关节半月板囊肿患者（均合并半月板损伤,其中2例合并前叉韧带断裂）在关节镜下经半月板滑膜缘入路进行囊肿切除术,同时修复半月板损伤。结果 23例患者获得随访,时间26-50个月。MRI检查均未发现囊肿复发;按国际膝关节评分委员会（IKDC）膝关节功能评分,术前为（67.2±4.1）分,末次随访时为（89.6±5.7）分。结论关节镜下经半月板滑膜缘入路能够完成膝关节半月板囊肿的彻底切除,并能够最大程度地保留半月板,手术效果好。     

Characterization and comparison of rat monosodium iodoacetate and medial meniscal tear models of osteoarthritic pain

Osteoarthritis (OA) is a degenerative form of arthritis that can result in loss of joint function and chronic pain. The pathological pain state that develops with OA disease involves plastic changes in the peripheral and central nervous systems, however, the cellular mechanisms underlying OA are not fully understood. We characterized the medial meniscal tear (MMT) surgical model and the intra‐articular injection of monosodium iodoacetate (MIA) chemical model of OA in rats. Both models produced histological changes in the knee joint and associated bones consistent with OA pathology. Both models also increased p38 activation in the L3, but not L4 dorsal root ganglia (DRG), increased tyrosine hydroxylase immunostaining in the L3 DRG indicating sympathetic sprouting, and increased phosphorylated (p)CREB in thalamic neurons. In MIA‐OA, but not MMT‐OA rats, p38 and pERK were increased in the spinal cord, and pCREB was enhanced in the prefrontal cortex. Using in vivo electrophysiology, elevated spontaneous activity and increased responsiveness of wide dynamic range neurons to stimulation of the knee was found in both models. However, a more widespread sensitization was observed in the MIA‐OA rats as neurons with paw receptive fields spontaneously fired at a greater rate in MIA‐OA than MMT‐OA rats. Taken together, the MIA and MMT models of OA share several common features associated with histopathology and sensitization of primary somatosensory pathways, but, observed differences between the models highlights unique consequences of the related specific injuries, and these differences should be considered when choosing an OA model and when interpreting data outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2109–2117, 2018.

     

关节镜下射频汽化仪治疗半月板损伤的应用

目的探讨关节镜下射频汽化仪与常规器械治疗半月板损伤术后近期疗效.方法将38例膝关节半月板损伤患者按纳入和剔除标准分为常规器械(CI)和射频汽化仪(RF)组,比较和分析两组手术时间、术后关节积液、膝关节屈伸度改善程度、术后临床症状改善程度和膝关节功能恢复程度.结果射频汽化仪组的手术时间为(28.50±2.97)min,明显少于常规器械手术组的(41.00±7.49)min,且RF组术后关节积液发生较少,为(6.0±1.41)ml,RF组术后膝关节活动度改善程度为(25.61±12.62)°,膝关节功能恢复程度为(40.0±10.55)分,均优于CI组的(15.55±10.01)°和(32.35±5.71)分结论使用射频汽化仪在关节镜下行半月板成形具有手术操作更加简单易行、创伤小和术后膝关节功能恢复良好的优点.     

关节镜下射频汽化技术治疗半月板损伤疗效观察

[目的]探讨关节镜下射频汽化技术治疗半月板损伤的临床疗效。[方法]对58例膝关节半月板损伤患者常规行关节镜检查,应用Arthrocare 2000射频汽化仪,先应用汽化钩,对损伤半月板不能保留部分进行切割、成形,对保留半月板边缘用汽化刷,均匀涂刷汽化,修整至平滑的楔面,使呈条丝状分离或松弛翘起半月板损伤部分紧缩和裂隙固定,并对出血点电凝止血。[结果]术后2 d行患膝屈伸功能锻炼,4周关节活动正常,平均随访2年,关节无肿胀及积血、疼痛、弹响、交锁症状消失。[结论]关节镜下应用射频汽化行半月板成形具有使半月板残缘修整成楔面及紧缩和裂隙固定功能,减少关节软骨磨损;并能术中止血,减少关节积液。