髌内侧滑膜皱襞综合征的诊断和关节镜治疗

髌内侧滑膜皱襞 ,是一发育残留的滑膜皱襞 ,由髌上内侧延伸至髌下脂肪垫滑膜上方。我院自 1998年以来在膝关节镜下证实并行滑膜皱襞切除术治疗该征 2 1例取得满意效果 ,报告如下。1　临床资料1 1　一般资料　本组 2 1例 ,其中男性 15例 ,女性 6例 ;年龄 2 9～ 74岁 ,左膝 8例 ,右膝 13例 ;单纯髌内侧滑膜皱襞综合征 14例 ;合并其它病变者 7例 ,其中外侧半月板损伤 4例 ,髌股关节炎 3例 ;平均病程 18个月。1 2　诊断　所有患者均诉有膝前痛和屈膝时弹响 ,5例患者有“胶着”感 (即久坐后开始行走时膝关节痛 ,活动后疼痛消失 ) ,3例有抬腿乏力 …     

微骨折术治疗膝骨关节炎与髌内侧滑膜皱襞的相关性

目的研究不同解剖类型髌内侧滑膜皱襞对微骨折术治疗膝骨性关节炎患者手术前后的影响。方法收集2011-04-2014-01在安徽医科大学合肥第三临床医院关节镜手术治疗的30例膝骨性关节炎患者。将有无合并髌内侧滑膜皱襞分成两组,进行手术前后膝关节功能Lysholm评分,统计学采用两样本t检验。不同解剖类型髌内侧滑膜皱襞分成两组,进行手术前后膝关节功能Lysholm评分,统计学采用两样本t检验。结果不合并内侧滑膜皱襞评分高于合并组,手术前后膝关节功能Lysholm评分均有差异（P〈0.05）。A,B型髌内侧皱襞手术前后Lysholm评分高于C,D型髌内侧皱襞手术前后Lysholm评分（P﹤0.05）;C,D型髌内侧皱襞更影响疗效。30例膝骨性关节炎患者手术前后膝关节功能Lysholm评分有差异（P〈0.05）,术后评分较术前大幅提高。结论微骨折术治疗膝关节骨性关节炎效果满意。不同解剖类型髌内侧滑膜皱襞影响膝骨性关节炎手术前后的评分。特别是解剖类型为C,D型。术中准确处理髌内侧滑膜皱襞对微骨折术治疗膝骨性关节炎至关重要。     

髌内侧滑膜皱襞综合征的诊断和治疗

目的探讨髌内侧滑膜皱襞综合征的诊断及治疗方法。方法回顾性分析2004年10月～2006年11月收治的单纯髌内侧滑膜皱襞综合征37例。将其临床症状、体征与关节镜检查进行比较,探讨临床诊断治疗方法。结果经关节镜检查证实,单纯膝关节滑膜皱襞综合征37例,其中术前诊断半月板损伤而术后诊断滑膜皱襞5例;滑膜皱襞B型4例,C型25例,D型8例。关节镜下动态观察,发现可解释症状的有病理改变的滑膜皱襞即可诊断。术后随访时间3～48个月,关节功能优良达89.2%,手术后无症状加重或感染病例,疗效与伴随的软骨损伤程度呈负相关。结论早期髌内侧膝关节滑膜皱襞综合征临床诊断较困难,认真详细的体格检查及造影后MRI检查有助于提高诊断准确率,关节镜是诊断和治疗髌内侧滑膜皱襞综合征的最佳方法。     

病理性滑膜皱襞组织神经解剖结构的分布规律研究

目的观察研究膝关节髌内侧滑膜皱襞综合征（MPS）患者病理性滑膜皱襞组织中神经解剖结构的分布规律。方法 膝关节镜下采集2007年5月至2008年11月实验组（MPS）20例和对照组11例（无症状滑膜皱襞）患者的髌内侧滑膜皱襞,采用LsAB和免疫荧光法进行蛋白基因产物9.5（PGP9.5）、P物质（SP）免疫组化染色,半定量测量神经分布区域密度,采用t检验比较实验组和对照组神经分布密度差异,采用配对t检验比较皱襞游离缘和基底部之间神经密度的差异。结果 （1）膝关节髌内侧滑膜皱襞中存在神经纤维的分布：神经结构主要呈游离神经纤维、神经纤维束、血管周围神经网络三种主要的形态存在,走行与血管相伴,主要分布于血管周围区域。（2）实验组PGP9.5阳性纤维密度（纤维/cm2）：滑膜皱襞游离缘为（190.17±91.66）,基底部为（334.39±115.68）;SP染色阳性纤维密度在游离缘为（153.63±100.73）,基底部为（282.95±126.10）。对照组PGP9.5阳性纤维密度为（37.65±22.91）;SP阳性纤维密度为（23.23±18.41）。两种神经染色方法均证实：（1）MPS组患者髌内侧滑膜皱襞中阳性纤维密度与对照组间的差异有统计学意义（P〈0.01）;（2）病理性髌内侧滑膜皱襞基底部阳性纤维密度明显高于游离缘（P〈0.01）。结论 膝关节髌内侧滑膜皱襞中存在神经纤维的分布,在引起髌股关节疼痛的病理性髌内侧滑膜皱襞中神经纤维分布明显增多,其分布规律为：皱襞基底部的神经纤维数明显高于游离缘;表达与疼痛的产生和传导密切相关的P物质染色阳性的感觉神经纤维明显增多提示髌内侧滑膜皱襞基底部区域是产生髌股关节疼痛的高危区域。     

单纯髌内侧滑膜皱襞综合征诊断及关节镜治疗

[目的]探讨膝关节单纯髌内侧滑膜皱襞综合征临床诊断、关节镜治疗及其疗效.[方法]2008年1月～2010年6月根据shelf征、MPP试验及MRI检查诊断并收治单纯髌内侧滑膜皱襞综合征患者32例,全部在关节镜下行内侧滑膜皱襞完全切除术.[结果]随访12 ～40个月.根据改良Lysholm评分标准,其中优27例,良4例,可1例,优良率96.9％.[结论]单纯髌内侧滑膜皱襞综合征可以根据shelf征、MPP试验及MRI检查共同确定临床诊断,应用关节镜技术可取得良好的治疗效果.     

髌内侧滑膜皱襞中表达P物质的神经分布与髌股关节痛的相关性

目的 研究病理件髌内侧滑膜皱襞中神经解剖结构变化.证实表达P物质的神经纤维分布增多足病理性髌内侧滑膜皱襞引起髌股关节痛的结构基础.方法 通过膝关节镜获取滑膜皱襞标本,采用免疫组化半定量分析方法观察P物质在膝关节髌内侧滑膜皱襞中的分布规律、变化趋势,比较空白对照组(无症状的滑膜皱襞)、阳性对照组(有症状的滑膜皱襞合并其他损伤)、实验组(有症状的滑膜皱襞)共51例患者髌内侧滑膜皱襞中表达P物质的神经纤维分布密度.结果 空白对照组髌上滑膜皱襞P物质染色阳性神经纤维密度为(24.60±26.17)根/cm2;阳性对照组为(117.36±73.62)根/cm2,实验组为(59.06±44.06)根/cm2.实验组髌内侧滑膜皱襞P物质染色阳性神经纤维密度为(255.44±87.91)根/cm2,阳性对照组为(268.00±71.60)根/cm2,空白对照组为(23.23±18.41)根/cm2.髌内侧滑膜皱襞神经纤维密度高于髌上滑膜皱襞.实验组与阳性对照组髌内侧滑膜皱襞中P物质染色阳性神经纤维密度均高于空白对照组,阳性对照组高于实验组.P物质神经纤维分布密度与VAS疼痛评分呈正相关.结论 病理性髌内侧滑膜皱襞中表达P物质的神经纤维分布密度与患者疼痛程度呈正相关.病理性髌内侧滑膜铍襞中表达P物质的伤害性疼痛感觉神经纤维是疼痛发生的重要神经病理学基础,是髌内侧滑膜皱襞综合征发病机制中的重要环节.     

关节镜治疗膝关节滑膜皱襞综合症临床疗效

滑膜皱襞综合征是引起膝关节功能障碍的常见病因之一[1]。滑膜皱襞是胎儿期膝关节滑膜隔板退化的残余，其中髌内侧皱襞与滑膜皱襞综合征关系最为密切[2]，我院自2003年12月-2013年6月在关节镜下共治疗膝关节滑膜皱襞综合征23例27膝，疗效满意。     

皱襞综合征

任何部份胚胎时期的滑膜皱褶残留到成年时即形成皱襞。最常见而症状很少的是髌下皱襞,称髌滑膜襞。残留的皱襞较少形成髌上与髌内侧皱襞。髌上皱襞将髌上囊与膝关节分隔开。髌上囊可以是密闭的,亦可有裂孔与膝关节腔相通。髌内侧皱襞为新月形的皱褶,自股四头肌腱到关节内侧壁。文献报道,正常膝关节内皱襞的发生率为20％～60％。自1980年以来,作者采用手术切除皱襞治疗20例皱襞综合征患者。随访时间15～28个月(平均20个     

孔针刀加手法治疗退变性膝关节炎

我们应用孔针刀加手法治疗退变性膝关节炎48例,收到显著疗效,介绍如下: 临床资料 本组48例中男16例,女32例,年龄在46～78岁间。病程最短6个月,最长25年,单膝36,双膝12,均出现患膝肿痛,跛行难蹲,屈伸受限,麦氏征阳性,在髌底、髌尖,髌股关节内、外上缘明显压痛,膝内侧压痛点者26例,膝外侧压痛点22例,胫骨结节压痛点18例,膝弹响32例,浮髌试验阳性21例,多有膝扭跌和劳累受寒加重     

膝内软组织异常致膝痛及功能障碍分析

慢性膝关节疼痛是骨科临床常见病 ,部分病人伴有运动初起的膝部功能障碍 ,这些症状不仅在中老年骨性关节炎病人出现 ,而且部分青壮年甚至少年病人中也有发生。从 1997年 3月～ 2 0 0 0年 3月 ,我们通过膝关节镜对 35 0例膝痛病人进行检查 ,发现除了关节软骨的损伤、半月板损伤外 ,髌下脂肪垫、髌上翼状皱襞、髌下前内侧滑膜皱襞的异常及不应出现的髌下前滑膜皱襞也是造成膝痛和膝部功能障碍的重要原因之一。现将其诊治情况及病因分析报告如下。1　临床资料本组 35 0例 ,男 6 9例 ,女 2 81例 ;年龄 15～ 81岁 ,平均 5 9 2 8岁。均有程度不同…     

双切口手术入路在膝关节镜中的应用

目的 探讨应用双切口人路进行关节镜诊治膝关节疾病的疗效。方法 对36例单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征患者应用双切口人路进行治疗。结果全部病例随访8．15个月。按Lysholm膝关节评分标准：优（〉90分）27例,良（80-90分）6例,可（〈80分）3例,优良率91．7％。结论 双切口人路在治疗单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征的关节镜手术中同样可以达到满意的诊断和治疗目的。     

Atraumatic hemarthrosis caused by a large mediopatellar plica

Hemarthrosis of the knee has various etiologies and is classified into atraumatic or post-traumatic. Among atraumatic factors, hemarthrosis due to synovial plica is extremely rare. We report a case of atraumatic hemarthrosis caused by the mediopatellar plica. A 21-year-old male truck driver was referred to our hospital, because of swelling and pain of the right knee without history of trauma. Bloody synovial fluid was aspirated by arthrocentesis. However, his symptoms recurred and persisted. The range of motion was normal, but the patient complained of anteromedial knee pain during maximum flexion. Routine biochemical analyses were within normal limits. Plain radiographs were normal. Magnetic resonance imaging (MRI) of the knee showed the hypertrophic mediopatellar plica and an irregular signal of the infrapatellar fat pad. Arthroscopy revealed a voluminous mediopatellar plica trapped between the patella and the medial femoral condyle. It attached to the center of the infrapatellar fat pad, the so-called tongue. When the tourniquet was released, fresh bleeding was observed from the region between the mediopatellar plica and the tongue. Because that region was considered to be the cause of the hemarthrosis, the mediopatellar plica and the tongue were excised. A histologic examination of the tongue showed evidence of bleeding with nonspecific synovitis. After the procedure, the patient was asymptomatic and there were no clinical signs of recurrence.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 4 (April), 2001: pp 415–417     

Review article: Plica syndrome of the knee

Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed. The morphology of knee plicae varies; mediopatellar plicae are the most common cause of the plicae syndrome. An intermittent dull pain is the most common symptom. Diagnosis is made by exclusion. Ultrasonography is useful; arthroscopy is the gold standard. Arthroscopic removal of the plica may be necessary when conservative treatment for up to 6 months fails.     

膝关节内侧滑膜皱襞综合征的关节镜诊治

目的探讨膝关节内侧滑膜皱襞综合征的临床诊断、关节镜诊断及疗效。方法回顾分析1996年1月～2007年12月收治的420例诊断为膝关节痛或半月板损伤或滑膜皱襞综合征的患者,其中有70例内侧滑膜皱襞综合征患者。按Sakakibara法分析其关节镜下形态,在镜视下行皱襞切除术、挛缩内侧支持带松解术,随访分析其疗效。结果70例内侧滑膜皱襞综合征中,镜下A型8例,B型13例,C型24例,D型25例。经镜下行皱襞切除,获得随访43例,随访时间为6个月～5年,平均32个月,按Lysholm法进行疗效评定,优良率90.7%。结论关节镜仍是该病确诊的"金标准",镜下彻底切除滑膜皱襞、松解挛缩内侧支持带是治疗该病有效的方法。     

Segmental arthroscopic resection of the hypertrophic mediopatellar plica

In a retrospective review of 64 knees (58 patients) treated during a 36-month period by segmental arthroscopic resection of a hypertrophic mediopatellar plica, each patient was questioned and/or examined a minimum of one year after surgery. Medial or retropatellar pain (95%), buckling (32%), swelling (25%), and snapping (16%) were symptoms associated with a hypertrophic mediopatellar plica. Findings during physical examination of medial and retropatellar tenderness (74%) suggest the presence of the condition. Thirty percent of knees had localized chondromalacia of the medial femoral condyle, while in 13% chondromalacia was localized to the medial patellar facet. Good to excellent results were obtained in 86% of knees with a hypertrophic mediopatellar plica, with or without localized chondromalacia. In patients who had associated conditions, the lesions were also treated arthroscopically; good to excellent results were obtained in 69% of these knees.     

关节镜下治疗膝关节内侧滑膜皱襞综合征

目的探讨膝关节内侧滑膜皱襞综合征的临床诊断、治疗方法及结果。方法自2006年10月至2010年11月期间,我院共诊治膝关节内侧滑膜皱襞综合征患者87例,其中46例采取保守治疗后症状无缓解而接受关节镜下手术切除滑膜皱襞。男24例,女22例;年龄23～72岁,平均年龄为41岁。按Sakakibara法对滑膜皱襞进行分类,在关节镜下行皱襞切除术,并随访记录其疗效。结果 46例经关节镜下皱襞切除的患者,其中A型27例,B型15例,C型3例,D型1例;同时合并9例半月板损伤,5例髌股关节内侧面骨关节炎形成。增生的滑膜皱襞均采用篮钳或刨削器将其切除。43例获得随访,平均随访时间为25个月,无复发病例。膝关节功能根据Lysholm评分进行评定,术后功能较术前明显改善,治疗结果优良率为90.7%。结论膝关节内侧滑膜皱襞综合征根据临床症状和MRI表现即可诊断,关节镜下可以确诊,同时镜下行滑膜皱襞切除可获得满意的效果。     

The medial plica: a clinical perspective

It has been nearly a century that medical community is discussing the existence of plica as a cause of knee pain. Still consensus has not been achieved over the management of this condition. Plicae are normal synovial infolds of the joint capsule, considered to be vestigial in nature, but can become symptomatic. We often get patients specially young and active adults with anteromedial pain of knee joint in our clinic. Injury to knee joint frequently precedes the development of symptoms, but regular overuse and chronic synovitis can also lead to pathological medial plica. Various etiological factors convert the normal elastic nature of medial plica to thick fibrous structure. This fibrotic band causes mechanical irritation and is also responsible for focal secondary chondromalacia. Clinical evaluation, history, and thorough examination of knee joint are necessary to establish the diagnosis and exclude other related pathological conditions. Various provocative tests that reproduce patient’s symptoms and a system to diagnose medial plica syndrome based on history and clinical examination have been described in literature. Newer imaging techniques, which are less hazardous and noninvasive, like dynamic ultrasonography and magnetic resonance imaging, are emerging as useful tools in diagnosing medial plica syndrome. Arthroscopy is the gold standard modality in diagnosing as well as treating the condition. It offers surgeons to inspect whole joint and assess personality of plica and resection in same session. Conservative therapy has a place in the management but arthroscopic complete excision of pathological medial plica provides excellent results.     

膝关节滑膜皱襞综合征发生机理探讨

目的:观察分析膝关节滑膜皱襞综合征的发生机理,探讨滑膜皱襞综合征的发生率、发生原因与年龄的关系,皱襞的部位、类型与临床症状体征的关系。方法:分组观察皱襞综合征的发生率及其发生原因的异同。结果:滑膜皱襞总发生率为56.78％,分组比较中老年组滑膜皱襞综合征发生率高于中青年组(P<0.05)。发生原因比较,中青年组创伤原因高于中老年组(x~2=38.33,P=0.000),磨擦退化原因,中老年组高于中青年组(x~2=45.53,P=0.000)。滑膜皱襞出现部位以髌内侧为主(74.50％),分型以C型和B型为主(91.84％)。结论:膝关节滑膜皱襞综合征以中老年多见,其中磨擦退化原因占39.70％,提示有必要将磨擦退化列为中老年滑膜皱襞综合征的发生原因之一。滑膜皱襞的部位及分型与临床症状体征相关并具有一定的临床特点。     

The clinical significance of the complete type of suprapatellar membrane

The plicae are synovial septa remaining in adult life that existed in early fetal life. The suprapatellar plica separates the suprapatellar pouch from the knee joint. The plica syndrome has clinical significance, which has been occasionally overlooked, but the pathophysiology of symptomatic plicae may be hard to explain. To evaluate the clinical significance of the suprapatellar plicae, the authors reviewed 34 cases in 23 patients with vague pain around the knee and a total septum of the suprapatellar plica at arthroscopic examination from September 1991 to December 1993. The follow-up period was from 6 months to 2 years and 9 months. The most common presenting symptom was chronic mild knee pain, aggravated by prolonged squatting or standing, with other patients reporting recurrent swelling, instability, giving-way, or a feeling of snapping. The objective findings include palpable band on the superomedial side, audible snapping, and local tenderness, but there were no significant abnormal findings in the laboratory. The radiographic findings were few, with sclerosis of the articular surface of the patella in 2(6%), malalignment in 1(3%), and mild degenerative change in 4 cases(12%). Five of 11 patients evaluated by bone scan had increased uptake around the patellofemoral joint, and 7 of 13 knees had a relatively small suprapatellar bursa on conventional arthrogram or pneumoarthrogram. At arthroscopy, a suprapatellar plicae with complete septum was identified in 30 of 34 cases (88%) and associated lesions presented as meniscal tears, loose body, and discoid meniscus without tear. The complete plicae were surgically excised under arthroscopic control in 30 patients and the results were excellent in 22 patients (73%), good in 5 (17%), and poor in 3 (10%)at 17 months follow-up; there were no failures. In our opinion, the complete suprapatellar plica is clinically significant in patients who have equivocal diagnosis of knee problems and further studies of the pathophysiology of complete suprapatellar plica are needed. (Arthroscopy 1998 Nov-Dec;14(8):830-5.)