急性膝关节损伤的关节镜应用浅析

目的：探究关节镜在急性膝关节损伤中的临床效果。方法选取收治的膝关节损伤患者80例,行膝关节镜手术治疗。实施术后随访,依照术后膝关节的稳定性、关节的疼痛程度、活动度及对生活质量的影响等指标开展疗效评估。结果关于膝关节功能的判定,80例患者中,优秀57例（71.3％）,良好15例（18.8％）,中等3例（3.8％）,较差5例（6.1％）。优良率合计达到90.1％,表明临床效果较显著。结论行膝关节镜手术对于治疗急性膝关节损伤有着显著的临床效果,手术创伤小,并发疾病少,术后功能恢复快,值得临床推广和借鉴。     

关节镜技术在膝关节软骨损伤诊治中的应用

1概论 关节软骨是无血液循环的结缔组织，损伤后自身修复能力很低，多需要进行填充、替代或重建关节功能。Hunter首先提出，受损严重的关节软骨无法自身修复，多数退变为骨性关节炎。有报道，在大样本膝关节镜检查中发现，约60％的患者存在软骨缺损或病变。目前的治疗方法尚难以形成正常关节软骨来进行替代修复，修复后的组织多为纤维样软骨或类似透明样软骨，     

关节镜治疗膝关节半月板损伤

采用关节镜行半月板部分切除术治疗膝关节半月板损伤35例,其方法操作方便、创伤小、恢复快,治疗效果满意。     

急性膝关节损伤早期关节镜检查的临床作用

２０例急性膝关节严重损伤的早期关节镜检查结果表明，关节镜下可直接观察关节内结构，发现损伤部位，判定损伤程度，有助于正确诊断和指导治疗，结合临床诊治经验，对关节镜下所见各种损伤结构的病理改变进行了分析讨论，结果提示，早期关节镜检查对急性严重膝关节运动损伤的诊断、治疗和康复具有重要的临床作用。     

膝关节损伤MRI表现与关节镜检查对照研究

目的分析研究膝关节半月板及韧带损伤的MRI表现，并与关节镜诊断结果相对照，评价MRI的临床应用价值。方法48例膝关节外伤患者均经MRI和关节镜检查。半月板损伤的分级标准采用Kaplan的三级分类方法。韧带损伤参照Ruiz进行分级。膝关节MRI检查采用常规序列：T1WI／SE，T2WI／TSE，STIR和GRE。关节镜检查由一名主任医师和一名主治医师共同完成。MRI检查后患者均于1～2周内行关节镜检查或手术。结果与关节镜检查结果比较，MRI诊断半月板损伤的准确率为85．4％，敏感性为92．1％，特异性为81．0％，阳性预测值为76．1％，阴性预测值为94．0％。MRI诊断韧带损伤的准确率为93．1％。然而，MRI对滑膜皱襞综合征、剥脱性骨软骨炎及创伤性滑膜炎诊断价值较低。结论MRI对膝关节半月板及韧带损伤诊断具有明显的临床应用价值，同时可作为关节镜术前的筛选工具，指导关节镜在临床中的合理运用。     

关节镜手术治疗急性膝关节损伤的围手术期护理

目的：探究科学优质围术期护理对实施关节镜手术治疗急性膝关节损伤患者的临床效果。方法选取2014年2月～2015年2月收治的手术患者116例,依照随机方式将其分为常规组与优质组,每组均为58例。对常规组患者实施常规护理,对优质组患者实施优质护理。结果优质组患者的护理效果明显比常规组患者好,且两组差异具有统计学意义（ P＜0.05）。结论实施优质围术护理可增强急性膝关节损伤患者手术疗效,改善临床症状,是一种较为理想的护理方式,为患者带去更为优质的护理服务。     

关节镜在诊断和治疗膝关节军事训练伤中的应用

膝关节损伤在临床上十分常见,绝大多数属运动性损伤[1]。在军事训练中,膝关节损伤的发生率较高,如不及时诊治,可严重影响训练。作者自2003-12~2006-06以来,共收治部队军事训练所致的膝关节内损伤69例,对其应用关节镜技术进行诊断和治疗,取得了较好的效果,现报告如下。1资料与方     

关节镜下手术治疗膝关节半月板损伤32例

随访３２例关节镜下手术治疗膝关节半月板损伤患者，疗效满意。临床资料随访１９９０年１０月～１９９３年１０月本科所行关节镜下手术的病例共７６例。其中半月板损伤共３２例（不包括盘状半月板损伤）。３２例中男１４例，女１８例；年龄最大５５岁，最小１８岁，平均３...     

关节镜治疗膝关节军事训练损伤418例临床分析

目的通过对418例膝关节军事训练损伤患者利用膝关节镜检查、治疗的结果进行分析,指导膝部军事训练损伤的及时诊断及治疗。方法回顾性分析2001年7月—2010年6月行膝关节镜检查治疗的现役军人伤病员共418例,其中男性412例,女性6例;年龄18~36岁,平均21.6岁。受伤原因:行军、越野跑、跨越障碍等损伤289例;器械训练、投弹训练、摔跤、足球、篮球运动等损伤116例;驾驶训练损伤13例。损伤类型:半月板损伤211例,前交叉韧带(ACL)损伤128例,后交叉韧带(PCL)损伤12例,多发韧带损伤22例,膝关节创伤性滑膜炎45例。分析关节镜下所见损伤的种类及治疗效果。结果关节镜下可见418例中前交叉韧带、后交叉韧带损伤及多发韧带损伤共计160例,半月板损伤211例,膝关节滑膜炎45例。术后95%以上病例功能恢复满意,无行走疼痛。结论军事训练致膝关节损伤常见,关节镜明确诊断并及时治疗,可最大限度地避免关节内结构的继发损伤。     

关节镜下缝合修复膝关节半月板损伤230例

目的 探讨关节镜下半月板缝合手术方法和操作技巧。方法 总结２３０例关节镜下半月板缝合术的操作经验,介绍术前半月板操作部位的定位：关节屈曲活动时,可以触及关节间隙部损伤半月板突起或凹陷,该部深压时,可激惹疼痛（疼痛再现）;术中半月板损伤的定位：滑膜增生,半月板表面粗糙,股骨髁关节面局限性软骨破坏,半月板活动度增加。结果 所有病人均在关节镜下顺利完成缝合修复手术,平均手术时间６０分钟。结论 关节镜下半     

Diagnostic and operative arthroscopy of the knee under local anesthesia with parenteral medication

Arthroscopy of the knee under local anesthesia was performed on 102 patients for operative and diagnostic purposes between January and December of 1985. The procedures were performed on a same day basis without a pneumatic tourniquet. The operative record of each patient was reviewed to determine postoperative diagnosis and treatment. The data was matched to a patient questionnaire that measured individual reaction to local anesthesia. The effectiveness and level of patient acceptance of this anesthetic technique for operative arthroscopy was then evaluated. Ninety-one patients responded to the questionnaire, 82 of whom had prior anesthetic experience. Ninety-five percent of the patients had minimal or no discomfort during the procedure. Eighty percent indicated a preference for local anesthesia in the event of subsequent arthroscopy. No complications relating to the anesthetic agent were noted. Arthroscopy of the knee under local anesthesia for routine operative arthroscopy was found to be safe, reliable, practical, and to have a high patient acceptance rate.     

关节镜下治疗化脓性膝关节炎30例临床观察

目的 探讨关节镜下清理及术后置管持续冲洗术治疗化脓性膝关节炎的疗效。方法应用关节镜下清理及术后置管持续冲洗术治疗30例化脓性膝关节炎患者。结果30例均获随访,时间为12～24个月。患者均治愈,无复发。根据膝关节功能判断疗效：优23例,良4例,中2例,差1例。结论关节镜下清理及术后置管持续冲洗术具有创伤小、清创彻底、恢复快的优点,配合早期功能锻炼,是治疗化脓性膝关节炎的有效方法,有利于关节炎症的消除和膝关节功能的恢复。     

The significance of arthroscopy in the diagnosis of acute knee injuries

Acute knee injuries were arthroscopically diagnosed in 32 patients from July 1988, to November 1989. Aiming to compare diagnostic reliability, knees were clinically examined before and after anesthesia had been induced, and arthroscopically. Arthroscopy revealed that ligaments were the most frequently injured. These injuries were diagnosed as dominant ones in 26 (79%) cases. Correct diagnosis was made in 10 (30%) injured, and by examination under anesthesia in 18 (55%) ones.     

人工膝关节置换术治疗膝关节重度骨性关节炎58例临床疗效

目的探讨人工膝关节置换术治疗膝关节重度骨性关节炎临床疗效。方法对58例重度膝骨性关节炎行人工膝关节置换术,观察患者术后HSS评分、膝关节屈曲挛缩度及关节活动度情况。结果对58例患者随访9~36(15±2)个月,2例膝切口局部脂肪液化,经换药愈合。其余患者均无切口及关节内感染或关节松动。疗效优49例,良5例,优良率为93.1%,膝关节HSS评分从术前(36.5±2.8)分增加到术后(90.6±6.3)分,关节活动度由术前(32.2±11.8)°增加到术后(98.5±13.6)°,膝关节屈曲挛缩度由术前(18.5±1.3)°降低到术后(0.4±0.1)°,差异有统计学意义(P<0.05)。结论人工膝关节置换术应用于严重骨性关节炎的治疗,能有效缓解疼痛,改善关节功能及生活质量。     

急性创伤性腰椎滑脱症的临床特点与手术疗效分析

目的总结急性创伤性腰椎滑脱症的临床特点,并观察手术治疗的效果。方法回顾性分析2000年1月～2004年6月收治的6例创伤性腰椎滑脱症的临床资料,通过6～28个月随访,观察经后路内固定、椎间及后外侧融合术的疗效。结果6例均为L5椎体滑脱;4例因治疗合并伤漏诊腰椎滑脱而使之成为陈旧性损伤;2例曾在外院行腰椎后外侧内固定术失败。本组术后腰痛症状完全缓解,1例翻修发生一过性神经根不全功能障碍;术后X线片示5例解剖复位(83．3％),融合率为100％。结论急性创伤性腰椎滑脱均为严重创伤所致,易发生在L5,因合并伤而致早期漏诊率较高。经后路内固定、椎间及后外侧融合术有望获得良好的临床疗效。     

Neurovascular complications of knee arthroscopy

During the last 3 decades, arthroscopy has revolutionized the way knee surgery is performed. The indications and the applications of arthroscopic procedures in the knee joint have enormously increased with the improvement in surgical technique and advent of new arthroscopic equipment. The use of arthroscopic techniques has led to a significant decrease in morbidity for the patient with intraarticular abnormalities, in terms of both diagnosis and surgical correction. Even though knee arthroscopy is a minimally invasive procedure with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. The reported incidence of neurovascular complication is low, but it may be underestimated. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure. It is imperative that the surgeon who is performing arthroscopy be aware of these neurovascular complications, recognize them as early as possible, and initiate further evaluation and treatment as expeditiously as possible. In this article, the causes, management, prevention, and medicolegal implications of neurovascular complications of knee arthroscopy are reviewed.     

MRI features of cortical desmoid in acute knee trauma

OBJECTIVE: The purpose of this study was to describe the MRI features of cortical desmoids associated with acute trauma. CONCLUSION: Marrow edema, periostitis, and adjacent soft-tissue edema can be seen in cases of cortical desmoid associated with acute trauma.     

膝关节镜下半腱肌及股薄肌肌腱重建前交叉韧带的临床观察

目的探讨膝关节镜下前交叉韧带重建的方法和效果。方法回顾分析26例膝关节镜下应用自体半腱肌及股薄肌腱以界面挤压螺钉及Endobutton固定重建前交叉韧带的临床资料,对患膝关节功能进行评估。结果术后随访12-18个月,根据Lysholm膝关节评分标准,由术前（54．7±9．13）分提高到术后（86．6±6．97）分。结论膝关节镜下采用自半腱肌及股薄肌肌腱重建前交叉韧带的方法可行,疗效满意,可作为重建前交叉韧带的方法广泛应用。