腘窝囊肿关节镜下内引流联合囊肿硬化治疗的效果

目的 探讨腘窝囊肿关节镜下内引流联合囊肿硬化治疗的效果。方法 回顾性选取2019-08至2021-07于海军军医大学附属第一医院骨科住院治疗的腘窝囊肿患者41例，男15例，女26例，年龄45～72岁，平均(62.5±5.38)岁。左膝16例，右膝23例，双膝2例。术前膝关节MRI证实伴有关节内疾病存在。先俯卧位后路经皮穿刺抽取囊液并注入硬化剂，后选取前内、前外侧常规关节镜入路处理相应关节内病变，术中切除关节腔-腘窝囊肿交通口处活瓣组织，行囊液内引流治疗。术后及随访期间根据Rausching和Lindgren膝关节腘窝囊肿分级法、膝关节MRI及腘窝处浅表软组织超声评估手术的效果。结果 41例均顺利手术，术中及术后无并发症；随访6～18个月，平均(9.45±3.47)个月，所有患者均未出现囊肿复发。手术前Rausching和Lindgren膝关节腘窝囊肿分级显示，0级0例，Ⅰ级16例，Ⅱ级22例，Ⅲ级3例；手术后6个月Rausching和Lindgren膝关节腘窝囊肿分级显示，0级32例，Ⅰ级7例，Ⅱ级2例，Ⅲ级0例；手术前后差异有统计学意义(Z=-3.896,P<0.05)。结论 ...     

膝关节半月板撕裂的MRI诊断

目的 探讨膝关节半月板撕裂的MRI诊断价值.方法 收集并分析经关节镜证实的60例膝关节半月板撕裂的MRI表现,并参考Stoller分级方法,提出半月板损伤的4级分法.结果 60例65个半月板撕裂中,内侧撕裂15个,外侧撕裂40个,两侧同时撕裂5例10个.合并外侧盘状半月板15个.MRI诊断准确率为90.8%.39例出现合并症,伴随病变有韧带撕裂,骨挫伤,关节积液,骨折,半月板囊肿等.结论 MRI能够准确诊断半月板撕裂,还能发现多种合并症.     

半月板根部撕裂与膝骨性关节炎严重度的关系

【摘要】目的：探讨半月板根部撕裂与膝骨性关节炎（KOA）的关系，并评价MRI对半月板根部撕裂的诊断价值。方法：回顾性分析2017年12月-2018年8月KOA患者59例，经关节镜证实有半月板根部撕裂的37例为观察组，无根部撕裂的22例为对照组，将两组膝关节进行的KL分级和Outerbridge分级后对比，并就MRI对根部撕裂及发生部位的诊断结果与关节镜的差异进行对比分析。结果：观察组的KL分级，Ⅰ级9例、Ⅱ级25例、Ⅲ级3例，对照组0级3例、Ⅰ级14例、Ⅱ级4例、Ⅲ级1例，两组间差异有统计学意义（Z=-3.847，P＜0.05）。观察组的Outerbridge分级，Ⅰ级1例、Ⅱ级6例、Ⅲ级12例、Ⅳ级18例，对照组0级1例、Ⅰ级5例、Ⅱ级2例、Ⅲ级10例、Ⅳ级4例，两组间差异有统计学意义（Z=-2.349，P＜0.05）。MRI对半月板根部撕裂发生（χ2=2.053，P=0.152）及部位（χ2=1.007，P=0.604）的诊断与关节镜结果差异无统计学意义。结论:半月板根部撕裂与KOA的严重程度相关，会导致KOA进展加速。而MRI对半月板根部撕裂有着高度敏感性，可辅助临床术前诊断。     

膝关节内侧半月板后根部撕裂的磁共振成像评价

目的 探讨膝关节内侧半月板后根部撕裂的磁共振（MRI）表现。方法 回顾性分析经关节镜确诊的膝关节内侧半月板后根部撕裂病例36例,分析MRI检查不同断面膝关节内侧半月板后根部撕裂的MRI表现以及撕裂显示率的差异性。结果 36例膝关节内侧半月板后根部撕裂均表现为形态失常,相应区域质子密度加权图像信号弥漫性增高,其中横轴位显示“裂隙征”10例,“圆钝征”10例,冠状位“裂隙征”34例,矢状位“幽灵征”35例。横轴位阳性征象显示率明显低于冠状位与矢状位（P均<0.01）。所有病例中,30例合并内侧半月板后角撕裂,34例合并半月板周缘性移位,其中Ⅰ度5例,Ⅱ度11例,Ⅲ度18例。32例合并胫股关节内侧骨软骨损伤,其中Ⅰ级2例,Ⅱ级4例,Ⅲ级10例,Ⅳ级16例。结论 膝关节内侧半月板后根部撕裂MRI表现具有一定特征性,以冠状位及矢状位显示最佳,且常合并半月板周缘性脱位及胫股关节内侧骨软骨损伤,临床工作中应注意全面评估。     

外侧半月板腘肌腱区损伤的缝合方法

目的介绍一种经前方关节镜入路进行全关节内半月板缝合的手术技术,探讨外侧半月板腘肌腱区安全、有效的修补方法。方法2002年7月至2006年5月,共采用经前方入路的全内缝合技术修补外侧半月板腘肌腱区损伤36例,其中合并前交叉韧带损伤26例,单纯桶柄样撕裂2例,盘状软骨损伤8例。常规关节镜前内及前外侧入路,缝合时关节镜置于前外侧入路,前内侧入路为缝合通道。膝关节屈曲90°位内翻,呈“4”字位。将预装配可吸收缝线的缝合钩通过前内侧入路置入关节内,在腘肌腱两侧分别进行缝合,关节内完成垂直褥式缝合、过线、打结、剪线的全部操作步骤。合并前交叉韧带损伤者同时行韧带重建手术,具备修补性的盘状软骨损伤者在修补术之前进行成形术。结果其中30例得到随访,平均随访25.8个月。采用临床检查及二次手术探查对半月板愈合状况进行综合评估。30例可随访病例全部进行了临床检查,均属于“无症状”,其中26例进行了二次手术探查,结果25例完全愈合,1例部分愈合,未发现不愈合病例。无明显手术并发症出现。结论经前方关节镜入路的全关节内缝合技术修补外侧半月板腘肌腱区损伤,可以达到牢靠的缝合效果,有效地避免损伤腘肌腱及腓总神经,获得较好的临床疗效。     

MRI在膝关节非肿瘤性病变中的应用

目的探讨MRI对膝关节非肿瘤性病变的诊断价值及其对临床治疗的指导意义。方法回顾性分析、对比118例膝关节病变的关节镜或手术结果与术前MRI结果。结果以关节镜或手术为金标准,MRI显示病变的准确性分别为韧带损伤77.1%(64/83),半月板损伤79.8%(67/84),其中半月板桶柄样撕裂88.9%(8/9),盘状半月板90.9%(10/11),软骨损伤78.3%(83/109),滑膜病变73.0%(27/37),关节囊受损100%(7/7),骨髓炎100%(4/4),游离体100%(12/12),腘窝囊肿100%(3/3)。结论 MRI能够准确评价膝关节各类疾病,尤其对病变程度、分期、范围及性质的判断。     

MRI与关节镜诊断半月板损伤价值的对照研究

目的 分析MRI诊断半月板损伤的价值,为临床诊断和治疗半月板损伤提供依据.资料与方法 符合纳入标准的168例患者(均为单膝半月板受损),共336个半月板.对膝关节进行术前MRI检查,并于MRI检查后8周内行关节镜术.半月板损伤的MRI分级标准参考Fischer分级法,分为Ⅰ级损伤、Ⅱ级损伤、Ⅲ级损伤;关节镜分级,分为正常、纤毛化和撕裂.结果 与关节镜结果对照,MRI诊断半月板Ⅰ、Ⅱ级损伤的准确性分别为100%、92.9%.诊断半月板撕裂的敏感性、特异性、阳性似然比、准确性、Kappa值分别为93.1%、89.3%、8.7、91.1%、0.82.对半月板撕裂类型诊断总的灵敏性、特异性、阳性似然比、准确性、Kappa值分别为92.0%、79.8%、4.6、84.8%和0.70.结论 MRI不仅能够准确评价半月板损伤程度,而且还能对半月板撕裂进行准确分型.因此,MRI可广泛应用于半月板损伤性疾病的诊断,并进一步指导临床治疗方案的选择.     

膝关节半月板囊肿22例MRI分析

目的：分析膝关节半月板囊肿的MRI特点，提高对该病的认识。方法：回顾性分析22例膝关节半月板囊肿的MRI表现并与关节镜或手术结果对照。探讨半月板囊肿发生的部位、形态、信号特征及与半月板的毗邻关系。结果：22例半月板囊肿中，内侧半月板囊肿4例(18．1％)，外侧半月板囊肿18例(81．8％)。22例半月板囊肿中显示半月板水平撕裂15例(68．2％)，纵行撕裂3例(18．1％)。结论：半月板囊肿好发于外侧半月板，并与半月板的撕裂相关，表明MRI对诊断半月板囊肿有较高的临床价值。     

MRI与关节镜诊断半月板损伤临床表现的对比分析

目的 探讨MRI和关节镜检查半月板损伤的诊断价值。方法 收集40例我院接受诊断与治疗的膝关节损伤患者的MRI图像,以关节镜诊断为标准,计算MRI诊断的敏感性、特异性、准确性。结果 本组40例膝关节,左膝18例,右膝22例,共80个半月板。MRI表现为Ⅰ度损伤9个,Ⅱ度损伤15个,Ⅲ度损伤56个。MRI诊断半月板撕裂56个,其中外侧半月板35,内侧半月板21个,关节镜证实半月板撕裂50个,其中外侧半月板32,内侧半月板18个,其余6个半月板关节镜下肉眼未见明显撕裂。24个半月板MRI诊断无撕裂者中,关节镜下证实有3个半月板撕裂并进行部分切除。以关节镜检查为标准,MRI对半月板撕裂诊断的敏感性为94.3%,特异性为77.8%,准确性为88.8%,MRI诊断与关节镜结果差异无统计学意义（x^2=0.44,P〉0.05）。结论 MRI对半月板撕裂具有较高的诊断价值。而关节镜检查为最终确诊半月板损伤提供了清晰的镜像和依据,两者相互补充才能得到更好的临床效果。     

彩色多普勒超声在腘窝囊肿诊断中的应用

腘窝囊肿又称为Backer囊肿。本文通过回顾性分析 38例窝囊肿病例 ,旨在探讨彩色多普勒超声在本病中的应用价值。1　材料与方法　　 38例超声诊断窝囊肿的病例 ,其中男性 2 1例 ,女性 17例 ,年龄最大的 6 8岁 ,最小者 11岁 ,平均年龄 4 7.3岁。男女之比为 1:1.2 ,其中 17例行MR成像检查。采用百胜AU 5彩色多普勒超声诊断仪 ,探头频率范围为 7.0～ 10 .0MHz。检查时患者充分暴露被检肢体 ,取侧卧 ,将患肢自然弯曲 ,或者俯卧将患肢垫高并放松肢体 ,探头置于窝处依次行纵切和横切扫查。仔细观察窝内的动、静脉血管、半月板及韧带组织…     

Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment.

The objective of this prospective study was to determine the prevalence of popliteal cysts and the associated intraarticular lesions in a group of 100 patients scheduled for arthroscopic surgery of the knee and to evaluate the results of arthroscopic treatment for these intraarticular lesions without removal of the cyst. One hundred patients without any knee complaints served as a control group. The diagnosis of a popliteal cyst was made on the basis of ultrasonography. The prevalence of popliteal cysts was 20% in the study group and 0% in the control group. Patients with a popliteal cyst had a significantly higher prevalence of medial meniscal tears (70% versus 19%) and of chondral lesions (85% versus 28%). Tears of the lateral meniscus, however, were more evenly distributed (20% versus 36%). Sixteen of 20 patients with a popliteal cyst were available for a follow-up examination 1 to 3 years after the arthroscopic procedure. Eleven popliteal cysts had persisted. Chondral lesions were the most relevant prognostic factor; all patients with persisting cysts had grade III or grade IV lesions. We conclude that the popliteal cyst is a secondary phenomenon and that treatment should address the underlying intraarticular lesions. In cases of osteoarthritis it may be impossible to treat the chondral lesion successfully in terms of eliminating the effusion.     

MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series

Magnetic resonance imaging (MRI) is the most widely used non-invasive test for assessing intra-articular injuries of the knee. It has been suggested that a negative MRI can be useful in avoiding the need for diagnostic arthroscopy in cases where clinical examination is equivocal. However, the sensitivity and specificity of MRI is not 100%, particularly for tears of the lateral meniscus. Furthermore, a false negative MRI scan may result in premature return to play in athletes, resulting in increased risk of further damage to a torn meniscus. To illustrate this issue, we present a case series of eight elite athletes who all presented with mechanical knee symptoms and where MRI scans revealed no significant intra-articular pathology. Five of the athletes were allowed to return to sport on the basis of a negative MRI. All patients were subsequently found to have a bucket-handle tear of their lateral meniscus at arthroscopy. Two independent, experienced musculoskeletal radiologists were asked to review the MRI films without being given any clinical history of the cases. Although injuries to the popliteus tendon were noted in two of the athletes who had sustained a recent acute injury to their knee, no meniscal tears were identified. Thus arthroscopy remains the gold standard for the assessment and management of high-demand patients with a clinical suspicion of meniscal pathology.     

Arthroscopic management of lateral meniscal cysts

This study presents seven cases of lateral meniscal cysts treated arthroscopically. All were noted to have meniscal lesions at the time of surgery; there were five flap tears and two radial tears. Partial arthroscopic meniscectomy was performed and the contents of the cysts were manipulated into the joint in six of seven cases. One patient underwent open cyst excision in addition to partial arthroscopic meniscectomy. Followup ranged from 18 months to 4 years with an average of 28 months. There were no cyst recurrences. The pathologic basis of the meniscal cyst is controversial, but recent work suggests the etiology is infiltration of joint fluid through micro and macro tears in the meniscus. Partial meniscectomy retains valuable meniscal function while minimizing the likelihood of cyst reformation. We found arthroscopic partial meniscectomy with manipulation of the contents of the cyst into the joint to be a successful alternative to complete open meniscectomy.     

Popliteal cysts: sonography evaluation after arthroscopic treatment

PURPOSE: To identify a set of sonomorphological parameters to evaluate the outcome of arthroscopic surgery for popliteal cysts by sonography. MATERIAL AND METHODS: We examined 30 patients (18 males, 12 females) before treatment and 3/6 months after arthroscopy. Patients were classified by clinical (4 groups) and sonographic criteria. The sonographic criteria were the morphological classification of the cysts (beak-shaped, X-shaped, grape-like, slit-shaped) and the volume measurement. RESULTS: Sonography identified beak-shaped popliteal cysts (the most frequent Baker cyst shape), 5 grape-like (the usual shape of complicated Baker cysts) and 1 X-shaped . The volume of cysts before treatment ranged from 5 to 38 cl. Most cysts were clinically rated as grade 2 (symptomatic and evident at physical examination, with a reduction of range of motion up to 20 degrees of flexion). No patient was rated as grade 0 (normal). After surgery the cyst was still evident at sonography. After 3 months we recorred a cyst volume decrease in all cases. Six months after surgery 29/30 cysts had a volume <5 cl with an almost virtual cavity that changed their appearance in to slit-shaped . In one case cyst volume increased. The clinical classification showed an increase of the grade 0 group unsymptomatic cysts (not detectable at physical examination). DISCUSSION AND CONCLUSIONS: Sonographic evaluation of popliteal cysts after arthroscopic surgical treatment allowed to recognize the cysts, which are not removed by this approach. The follow-up at 3 months showed a reduction in cyst volume. After six months, in the cases with a good surgical response, the cysts reached a volume <5 cl regardless of their original volume. The morphology of the cysts with a good surgical result, is slit-shaped with virtual cavity regardless of their original appearance. There is a high correlation between sonographic and clinical data. We believe that the volume reduction of the cyst three months after surgery is a good predictive element. After six months the preesence of a cyst with a volume <5 cl and a slit-shape with virtual cavity is a sign of good surgical result.     

Intra-articular cysts and ganglia of the knee: a report of nine patients

Completely intra-articular cysts and ganglia of the knee are rare. They have been found in various locations such as on the anterior or posterior cruciate ligaments, in the infrapatellar fat pad, on the posterior wall of the posteromedial compartment and (very rarely) in connection to the menisci. We analyzed nine patients with intra-articular cysts or ganglia found in a series of 2,400 consecutive arthroscopies. In four patients, the cyst or ganglion was found attached to the anterior part of the ACL, in two patients it was located between the ACL and the PCL, and in the remaining three cases it was found in connection with the meniscus. In three out of the nine patients there was either no or very minor additional pathology found in the knee besides the cyst or the ganglion. We believe that intra-articular cysts and ganglia of the knee can be symptomatic, and excellent or good results after cyst removal can be expected especially when there is little additional pathology.     

探讨关节镜治疗膝关节盘状半月板损伤的临床疗效及术后疼痛的影响因素

目的研究并探讨关节镜治疗膝关节盘状半月板损伤的临床疗效,并对导致其术后疼痛的影响因素进行分析。方法回顾性分析2013年1月—2016年8月宁夏人民医院骨科收治且随访成功的200例膝关节盘状半月板损伤患者的临床资料。男性86例,女性114例,年龄12~76岁,平均45.24岁。左侧膝关节半月板损伤103例、右侧97例,损伤类型均为圆盘状;损伤分度依据MRI信号进行划分,Ⅰ度32例、Ⅱ度67例、Ⅲ度101例。所有患者均接受关节镜手术治疗,对其治疗效果进行观察,统计术后出现疼痛的病例,并分为疼痛组、无痛组,比较两组患者的Lysholm膝关节功能评分,并对两组患者的各项临床资料进行比较,对导致患者术后疼痛的影响因素进行单因素、多因素Logistics回归分析。结果经关节镜手术治疗后,200例患者的疗效评定结果为优119例、良75例、可4例、差2例,优良率为97.0%。术后56例患者出现膝关节疼痛,疼痛发生率为28.0%。疼痛组患者手术后的Lysholm评分(67.62±12.21)分明显低于无痛组(83.45±13.57)分(P0.05)。经单因素分析、多因素Logistics回归分析后得出,导致术后疼痛的影响因素主要为患者年龄大、关节软骨损伤、术后过早负重、术后未接受冷敷。结论关节镜治疗膝关节盘状半月板损伤的临床疗效显著,但术后患者容易出现膝关节疼痛,临床上应针对术后疼痛发生的相关因素进行相应的处理。     

Prevalence of meniscal radial tears of the knee revealed by MRI after surgery

OBJECTIVE: Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. These forces are oriented centrifugally on the meniscus by normal weight-bearing and are distributed by circumferentially oriented fibers. This alteration may predispose the knee to radial tears after surgery. SUBJECTS AND METHODS: One of three musculoskeletal radiologists prospectively interpreted 100 consecutive postoperative MRI examinations of the knee. A prospective MRI report was generated for the referring orthopedic surgeon, and prospective MRI interpretations were correlated with arthroscopic findings (n = 63). MRI examinations on those patients who underwent second-look arthroscopy were retrospectively reviewed by three musculoskeletal radiologists who reached a consensus on the prevalence of new postoperative meniscal radial tears. MRI criteria for radial tear diagnosis were used as outlined by Tuckman et al.: truncation, abnormal morphology, lack of continuity, absence of the meniscus, or any combination of those criteria on one or more MR images. An additional criterion used was abnormal increased signal in that area on T2-weighted images. RESULTS: Thirty-two of the 100 patients had meniscal radial tears on prospective MRI interpretations. In 29 of these 32 patients, second-look arthroscopy confirmed meniscal radial tears in the areas described on the MRI examinations. Five additional radial tears were shown on second-look arthroscopy that were not seen on prospective MRI interpretations. Two of those additional five radial tears were seen on consensus retrospective MRI review. CONCLUSION: In this study, a 32% prevalence of meniscal radial tears in the postoperative knee was present on prospective MRI interpretations as opposed to a reported 14% prevalence in the nonoperated knee. Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. This circumstance may increase the prevalence of meniscal radial tears in the postoperative knee. New meniscal radial tears are common in patients presenting with pain after knee surgery.     

The importance of arthroscopy in sports injuries in children and adolescents

Within a 3-year period (1985–1988), 60 children and adolescents with knee injuries sustained mainly while skiing or playing football (soccer) underwent clinical examination, X-radiography and arthroscopy. Nearly all the patients still had open epiphyseal plates in the knee region. Arthroscopy revealed more severe intra-articular trauma than had been suspected on the basis of clinical findings. The skiing injuries most commonly involved anterior cruciate ligament tears, whereas injuries of the patellar retinaculum and medial meniscus lesions predominated in soccer injuries. On comparison with arthroscopic diagnosis, clinical diagnosis was erroneous in about 45%. The sost common mistaken clinical diagnosis was medial meniscus tear. Of the 60 knee joints subjected to arthroscopy, 40 were severely enough injured to warrant surgery. Only one had normal intra-articular findings. The study demonstrates that children and adolescents can suffer knee trauma requiring surgery, despite open growth plates. Downhill skiing and soccer are particularly risky sports in this respect. Therefore, sports injuries involving haemarthrosis are clearly an indication for arthroscopy, even in childhood and adolescence. Arthroscopy enables early identification of the type and extent of intra-articular trauma and subsequent early initiation of appropriate therapy.     

Conservative treatment for a symptomatic solitary ganglion cyst of the anterior meniscus invading into the infrapatellar fat pad

Symptomatic meniscal cysts without accompanying meniscal tears are uncommon, especially those which are formed from the anterior meniscus and invading into the infrapatellar fat pad (IPFP). The current recommended treatment for such cysts is excision through open method or arthroscopy. To our knowledge, this is the first case study about a symptomatic solitary meniscal cyst invading the IPFP that was successfully treated with needle aspiration and steroid injection after arthroscopic treatment of the associated disorders. In this paper, similar cases are also reviewed to discuss the treatment and the link between meniscal cyst and meniscal tear.