可吸收锚钉修复前交叉韧带部分损伤的早期疗效观察

目的探讨关节镜下可吸收锚钉修复前交叉韧带部分损伤的早期疗效。方法 2013年12月—2015年2月,收治22例前交叉韧带部分损伤患者。其中男12例,女10例;年龄20~44岁,平均27.5岁。左膝8例、右膝14例;受伤至入院时间2~13 d,平均9.8 d。合并半月板损伤16例。关节镜下采用可吸收锚钉修复损伤的前交叉韧带。采用Tegner评分、Lysholm评分及国际膝关节文献委员会(IKDC)评分评价患者膝关节功能,同时采用疼痛视觉模拟评分(VAS)评估患者主观满意度;采用KT-1000测量仪评估膝关节松弛度,并行MRI检查评价韧带恢复情况。结果术后患者切口均Ⅰ期愈合,无手术相关并发症。患者均获随访12个月。随访期间患者均未出现前交叉韧带二次损伤。术后12个月Tegner评分、Lysholm评分、IKDC评分与受伤前比较,差异均无统计学意义(P0.05);患者主观满意度VAS评分为9~10分,中位数为9.5分;双侧胫骨前移差值为0~6 mm,中位数为0.5 mm。MRI结果提示22例患者连续性、纤维化信号强度分级均为1级。结论关节镜下可吸收锚钉修复前交叉韧带部分损伤可行,术后膝关节功能基本恢复正常,患者满意度高,早期疗效较好。     

成形联合修补术在盘状半月板损伤治疗中的应用

目的:观察半月板成形联合修补技术在治疗盘状半月板损伤的疗效。方法:2005年6月至2009年12月,28例行关节镜下盘状半月板成形术联合修补缝合技术,年龄6～42岁,平均32岁;男23例,女5例。关节镜下判定半月板的性质和撕裂的类型与范围,采用成形联合修补缝合技术治疗盘状半月板边缘撕裂,术后支具保护8周,6个月内避免剧烈运动。术后采用Lysholm关节功能评分标准进行疗效评定。结果:术后随访3～36个月,平均8个月。Lysholm关节功能评分:术前62～74分,平均(67.23±5.24)分;术后80～96分,平均(87.24±5.26)分。未出现再撕裂或因为症状复发再手术的病例。结论:盘状半月板成形术联合边缘破裂修补缝合技术对于盘状半月板撕裂的治疗具有较好的临床效果,可以作为其手术选择方案之一。     

关节镜治疗盘状半月板损伤的临床分析

目的探讨关节镜手术治疗症状性膝关节盘状半月板的方法和疗效。方法 2010年1月至2011年7月,采用关节镜微创手术对39例膝关节盘状半月板损伤的患者进行治疗,男11例,女28例;年龄18～62岁,平均34岁。术后早期进行关节功能锻炼,应用Lysholm膝关节功能评分系统对手术疗效进行分析。结果所有病例均获随访,时间6～24个月,平均12.5个月。术前膝关节Lysholm评分平均为（62.2±7.8）分,术后随访时平均为（92.6±4.6）分,前后比较差异有统计学意义（P〈0.01）。结论关节镜手术治疗盘状半月板损伤具有创伤小、并发症少、恢复快的优点,是治疗盘状半月板损伤的理想方法。     

关节镜下两种方法治疗胫骨髁间嵴骨折的疗效对比

目的比较关节镜下缝线套扎方法和可吸收带线锚钉方法治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。 方法选取2012年6月至2018年2月解放军总医院第一医学中心骨科收治的62例损伤3周以内、伤前患肢功能正常的前交叉韧带胫骨止点撕脱骨折患者为研究对象,同时排除伴有开放性骨折、多发骨折或胫骨平台、半月板及韧带损伤的患者。根据手术方法不同将其分为两组,其中关节镜下应用缝线套扎方法治疗30例患者,关节镜下应用可吸收锚钉方法治疗32例患者。比较两组患者的手术时间、术中出血量;通过前抽屉试验、Lachman试验(屈膝30°前抽屉试验)、轴移试验检查比较两组患者膝关节稳定性;通过Lysholm评分、国际膝关节文献委员会(IKDC)2000膝关节功能主观评分比较两组患者膝关节功能情况。计量资料组间比较采用独立样本t检验,组内比较采用配对t检验,计数资料组间比较采用卡方检验。 结果两组患者手术切口均一期愈合,术后3个月X线检查示髁间嵴撕脱骨折均愈合。缝线套扎组随访13～42个月,平均(22±8)个月;可吸收锚钉组随访12～39个月,平均(19±7)个月。可吸收锚组手术时间低于缝线套扎组,差异有统计学意义(t＝2.491,P <0.05),两组术中出血量差异无统计学意义(t＝1.506,P>0.05)。两组患者术后6个月Lysholm评分较术前提高,差异有统计学意义(缝线套扎组：t＝26.265,P<0.05;可吸收锚钉组：t＝29.857,P<0.05),两组患者术后IKDC 2000膝关节功能主观评分较术前提高,差异有统计学意义(缝线套扎组：t＝35.619,P <0.05;可吸收锚钉组：t＝37.004,P<0.05),术后6个月两组患者膝关节前抽屉试验、Lachman试验、轴移试验及Lysholm评分、IKDC 2000评分差别无统计学意义(P>0.05)。 结论关节镜下缝线套扎方法与可吸收锚钉方法治疗胫骨髁间嵴撕脱性骨折各有其特点,但临床治疗效果相同,均能够实现骨折块有效复位、牢固固定以及骨折愈合,有效恢复患肢功能,获得良好疗效。     

成形缝合术治疗外侧盘状半月板损伤的短期疗效

目的回顾分析关节镜下成形联合缝合修补术治疗不稳定外侧盘状半月板损伤的手术方法和短期疗效。方法采用关节镜下半月板成形缝合术治疗不稳定外侧盘状半月板损伤患者22例（24膝）,随访时采用Lysholm评分评价手术疗效。结果术后随访12～30个月,平均18．1个月。术前Lysholm评分（62．3±5．4）分;术后12个月（93．4±5．6）分（P〈0．05）,优良率为95．5％。结论只要手术指证掌握正确,采用关节镜下半月板成形联合缝合修补术治疗不稳定外侧盘状半月板手术效果良好。     

Twinfix双固定锚钉治疗膝关节内侧副韧带断裂临床效果观察

目的观察锚钉治疗膝关节内侧副韧带断裂的手术过程及术后治疗效果。方法本院采用带有可吸收线的锚钉治疗膝关节内侧副韧带损伤病人24例,术后进行功能锻炼,关注病人功能恢复情况,创口愈合之后病人出院。术后随访3～12月,病人定期复查,进行Lysholm评分。结果优22例,良2例,受伤至手术时间2～14天,平均8天。结论应用带有可吸收线的锚钉修复膝关节断裂内侧副韧带的手术简单,并发症少,效果良好。     

膝关节半月板损伤的手术修复疗效观察

目的探讨切开直视下及关节镜下缝合修复半月板损伤的疗效及术后并发症发生情况。方法1988年1月～2004年6月采用切开直接缝合法和关节镜下缝合修补方法修复半月板损伤168例170个。关节镜下方法包括穿刺打磨修复法、可吸收半月板箭复位固定法、Outside-In缝合法、Inside-Out缝合法、Elite肩袖缝合器缝合法、T-Fix固定技术和FasT-Fix固定技术。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果进行评价,并对术后的并发症进行观察。对有明显症状及体征的患者进行关节镜探查。结果所有患者获得6个月～9．5年(平均49．3±28．8个月)随访发现,Tegner评分：术前3．3±2．3,术后6．8±2．1(p＜0．05)。Lysholm评分：术前30．1±18．2,术后87．5±22．5(P＜0．01)。按Molster对Lysholm评分的分级方法,优98个,良57个,可10个,差5个,优良率为91．2%。对术后症状和体征明显的19例患者进行关节镜再探查,发现5例术愈合,6例部分愈合。术后并发症包括Outside-In缝线打结处疼痛3例,外侧半月板前角Outside-In缝合后未愈合导致后关节囊牵拉痛1例,半月板箭固定处的后关节囊刺痛5例。无严重血管、神经损伤,术后并发症的总发生率为5．3%。结论选择适当方法对损伤半月板进行修复可明显改善膝关节的症状和功能评分,并且具有较高的手术成功率和较少的术中、术后风险。     

老年膝关节半月板损伤关节镜手术方式选择及疗效评估

目的:探讨关节镜治疗老年半月板损伤的方法和疗效。方法 :自2014年1月至2018年6月,86例符合纳入标准的老年半月板损伤患者,其中男35例,女51例;年龄60～76岁,平均63.7岁;有明确外伤史32例,无明确外伤史54例。关节镜下半月板部分切除75例,部分切除及前角修补2例,部分切除及体部修补2例,后角水平分层破裂部分切除及修补7例;28例合并关节轻度退变,同时行髁间窝钻孔减压。术前及末次随访采用Lysholm评分和IKDC评分评定膝关节功能,视觉模拟评分法(VAS)评估疼痛情况。结果:所有病例成功完成关节镜下手术,随访6～36个月,平均15个月。膝关节Lysholm评分由术前(51.26±12.00)分,提高至末次随访的(81.20±4.89)分(t=22.07,P0.001);IKDC评分由术前(48.05±10.68)分,提高至末次随访的(76.97±6.26)分(t=23.04,P0.001);VAS由术前(3.37±0.84)分,改善至末次随访的(0.57±0.62)分(t=36.27,P0.001)。2例非外伤性退变性内侧半月板损伤伴内侧骨关节炎患者,术后1年症状无明显改善,行人工全膝关节置换术。结论:老年膝关节半月板损伤行关节镜下半月板部分切除,或部分切除及修补术治疗,可获得较满意的临床效果;如果合并关节轻度退变性变,同时行髁间窝钻孔减压。     

应用关节镜治疗膝关节盘状半月板的疗效分析

目的探讨关节镜下手术治疗膝关节盘状半月板损伤的疗效。方法对本院骨科在2006年1月～2009年6月收治23例膝关节外侧盘状半月板损伤在关节镜下手术进行回顾性分析。根据盘状半月板损伤情况分别施行半月板全切除术和次全切除术11例,部分切除7例和半月板成形术5例。手术前和手术后6个月均采用Lysholm评分对膝关节功能进行评分。结果本组病人术后未发生切口感染,关节内感染,明显的关节积血,血管神经损伤和下肢静脉血栓形成等并发症。术后活得随访21例,随访时间8～28个月,平均13.2个月。所有患者术后膝关节疼痛及肿胀症状消失或明显减轻,关节活动恢复正常。手术前Lysholm评分为52～92分,平均为69.2分,手术后6个月提高至79～92分,平均为86.6分。手术前后Lysholm评分具有显著性差异(P<0.01)。结论关节镜技术治疗膝关节外侧盘状半月板具有损伤创伤小、手术时间短、术后恢复快等优点,是作为临床治疗膝关节盘状半月板的首选术式。     

关节镜下使用带鞘可吸收挤压钉固定胫骨端重建前交叉韧带

目的介绍在关节镜下重建前交叉韧带（ACL）手术中使用带鞘可吸收挤压钉（Itrafix系统）固定胫骨端腱的方法。方法2006年8月至2007年12月我科共诊治39例ACL损伤患者,取自体半腱肌与股薄肌腱,在关节镜下使用带鞘可吸收挤压钉（Itrafix系统）固定胫骨端,使用2枚横向钉固定股骨端,重建ACL。观察此方法固定的稳定性以及术后疗效。随访后用Lysholm评分标准评价手术前后关节功能。结果本组患者39例,随访5～21个月,平均13个月。关节活动均恢复正常,Lysholm评分较术前提高,术前55.0±7.5提高至术后93.0±5.1,差异有统计学意义（P〈0.01）。术后关节腔积液3例,治疗后1周症状消除。结论关节镜下胫骨端使用带鞘可吸收挤压钉（Itrafix系统）、股骨端使用2枚横向钉固定,重建ACL近期疗效好,操作简单,移植物固定稳定,并发症少。     

Zone-specific inside-out meniscal repair: technical limitations of repair of posterior horns of medial and lateral menisci

Arthroscopy was performed on 15 cadaveric knees to assess the technical limitations of a zone-specific inside-out meniscal repair system (Linvatec Zone Specific II; Linvatec Corp, Largo, Fla) for accessing the posterior regions of the menisci. In addition, this system was compared with an all-inside technique (Bionx Arrows; Bionx Implants Inc, Blue Bell, Pa). Linvatec meniscal sutures and Bionx Arrows were placed arthroscopically in both medial and lateral menisci in all 15 cadaveric knees before open dissection was performed to evaluate device placement. Results showed that the Linvatec sutures may not adequately access a longitudinal 16.1-mm region of the posterior horn of the medial meniscus that is accessible with Bionx Arrows. In addition, the zone-specific inside-out technique excluded a statistically significantly larger region of the posterior horns of both menisci. With the Linvatec sutures, placement was difficult in the most posterior 14.9 mm of the medial meniscus and 10.8 mm of the lateral meniscus; with the Bionx Arrows, placement was difficult in only the most posterior 6.1 mm of the medial meniscus (P = .004) and 5.3 mm of the lateral meniscus (P < .006).     

Meniskusrefixierung: Faden oder Anker?

Suture techniques are the standard for fixation of meniscus bucket-handle lesions. In 1993 a new method for meniscus repair with self-reinforced biodegradable "arrows" was introduced. Currently, various meniscus implants are available in Germany and are widely used clinically. The purpose of this paper was to evaluate and discuss the literature on biodegradable meniscus implants. Relevant articles were retrieved from Medline of the National Library of Medicine (1966 until July 2000) using the combined search strategy for the keywords "meniscal repair" and "arrow." Ten publications were found. The reported advantages of meniscus arrows are the reduced operation time, the easy surgical technique, and the reduced risk of neurovascular injury. In most experimental studies, lower failure strength of meniscus arrows was found compared to meniscus sutures. In clinical studies, the meniscal healing rates comparing the arrow technique and suture technique are comparable. Various complications of the new arrow technique have been reported such as inflammatory foreign-body reaction, cartilage lesions, and arrow displacement. Based on the existing literature, no final judgment is possible. Currently, individual indications depending on the kind of meniscal lesion and location are recommended. A combination of suture and arrow technique might be a treatment option, but further prospective randomized studies and longer follow-ups are necessary.     

Biodegradable arrows for arthroscopic repair of meniscal tears

Thirty-two meniscal tears in 32 patients were repaired using biodegradable meniscus arrows. The tears were fixed arthroscopically using an all-inside technique. Ten patients had a simultaneous anterior cruciate ligament (ACL) reconstruction. The period of follow-up was an average of 25 (10-40) months. Twenty-six patients were clinically stable and asymptomatic at follow-up. Six patients were considered clinically unstable and all had associated ACL reconstruction and required a repeat arthroscopy. Two meniscal repairs failed to heal, and the broken meniscus arrow was retrieved arthroscopically 6 months after the primary operation. In four cases the meniscal tear healed completely (two cases) or partially. Otherwise, there were no objective signs of complications. The use of meniscus arrows is a simple, safe, and reliable method for repair of properly selected meniscal tears.     

Clinical results of arthroscopic all-inside lateral meniscal repair using the Meniscal Viper Repair System

Purpose

This study examined the postoperative outcome of the all-inside arthroscopic meniscal suture repair technique using the Meniscal Viper Repair System for lateral meniscus tears.

Methods

Between January 2006 and December 2008, 57 patients (27 males and 30 females) with lateral meniscus tears who underwent meniscal repair using the Meniscal Viper Repair System were evaluated prospectively. Among them, 52 cases were tears involving the posterior third of the lateral meniscus, and most were longitudinal tears or bucket handle tears. The postoperative follow-up period ranged from 12 months to 4 years and 2 months, and averaged 19 months.

Results

Both Lysholm and Japanese Orthopaedic Association Score were significantly improved after surgery. Forty-nine of 57 patients (86.0 %) had no locking or catching, no joint line tenderness, and a negative McMurray test at the last follow-up. Of 32 patients who underwent second-look arthroscopy, 24 achieved complete healing, while four showed partial healing and required repeat repair, and four showed no healing and meniscectomy was conducted. The failure rate in all patients was thus 14.0 % (8 of 57 repairs). No major complications associated with the use of the Meniscal Viper Repair System were observed.

Conclusion

The Meniscal Viper System is a convenient and effective device for all- inside lateral meniscal suture, with high success rate and no major complications.     

经胫骨隧道悬吊固定治疗半月板后根部撕脱损伤

目的观察关节镜下经胫骨隧道拉出悬吊固定技术治疗半月板后根部撕脱损伤的临床效果。 方法自2014年9月至2017年12月,对20例前交叉韧带损伤伴随半月板后根部撕脱损伤的患者,在前交叉韧带单束重建的同时采用关节镜下经胫骨隧道拉出悬吊固定技术修复半月板后根部撕脱损伤。纳入前交叉韧带损伤伴随半月板后根部撕脱损伤的患者,排除术前下肢力线异常者及合并软骨损伤者。术前和术后1年时通过Lysholm评分和Tegner评分对患者膝关节功能进行评估,并通过磁共振(MR)观察术后半月板后根部撕脱损伤愈合情况。定量资料比较采用配对样本t检验。 结果所有患者均进行超过1年的随访,患者术后1年随访时Lysholm评分及Tegner评分较术前均有显著提高(t＝7.98、5.55,均为P<0.05);且MR观察未发现半月板后根部再撕裂或半月板体部外凸。 结论关节镜下经胫骨隧道拉出悬吊固定技术可将半月板后根部撕脱复位并稳定固定于其解剖止点区域,从而维持半月板的环状结构以期最大程度恢复膝关节的功能,短期临床效果良好。     

Isolated meniscal repair in the avascular area

The authors present the results of a prospective cohort study carried out in young patients, to evaluate the outcome of meniscal repair in the avascular region of the meniscus. Forty five patients underwent either open (23 patients) or arthroscopic repair (22 patients) between 1982 and 1992. Seventeen men and eight women were included in the present study; their ages at the time of admission ranged from 16 to 27 years. They all presented with isolated longitudinal tears in the central avascular region of the meniscus. No patient with any kind of concomitant lesion was included in this series. The stitches were usually passed through the injured area and the synovium, and the knots were tightened outside the capsule. Twenty five patients of the total series, were subjected to a clinical examination in 1993, 9 to 54 months after meniscal suture. The Lysholm Knee Rating Score and the Tegner Activity Test were used. During 1999, these patients responded to a written questionnaire, based on the above mentioned rating scales. Among the 25 patients, there were 4 recurrences (16%), 2 fair results (8%) and one partial healing (4%). Eighteen (72%) patients, among which eight were treated using the arthroscopic technique, have shown favourable results, without any symptoms from the tibiofemoral joint, based on clinical examination and on the Lysholm Rating Scale and the Tegner Activity Test. When confronted with meniscal tears where there is doubt regarding the vascularity of the injured area, surgical repair in the avascular zone appears to provide a reasonable probability of healing, with good clinical outcome.     

关节镜下膝关节外侧半月板后角Fast-Fix缝合的疗效观察

目的 评价关节镜下采用Fast-Fix缝合装置治疗外侧半月板后角损伤的疗效.方法 2008年12月～2011年12月,治疗26例膝关节外侧半月板后角损伤患者,术前Lysholm评分(56.3±4.6)分,按Ikeuchi膝关节评价等级,26例均为差.根据关节镜下所见损伤的情况,采用Fast-Fix缝合装置缝合损伤的外侧半月板后角,观察术后膝关节功能恢复情况.结果 术后无感染、血管神经损伤、关节活动受限等并发症的发生.术后12个月Lysholm评分提至(89.2±3.4)分(t=-29.423,P=0.000).按Ikeuchi膝关节评价等级,优22例,良2例,可2例,优良率92.3％(24/26).随访满24个月16例,Lysholm评分(90.6±2.4)分,Ikeuchi膝关节评价等级优14例,良1例,可1例,优良率93.8％ (15/16).结论 关节镜下采用Fast-Fix缝合损伤的外侧半月板后角治疗膝关节外侧半月板后角损伤,效果满意.     

半月板成型缝合术在盘状半月板撕裂中的近期临床效果评价

目的评价半月板成形术结合Fastfix及MM-Ⅱ缝合技术在膝关节外侧盘状半月板撕裂中的近期临床效果。方法 2010年1月至2012年12月,对59例膝关节盘状半月板撕裂患者进行了半月板成型及缝合术。根据撕裂的大小和部位,采用Fast-fix缝合系统及MM-Ⅱ缝合套管针进行缝合。59例随访12~26个月,平均（18.4±3.6）个月。在术前及术后随访时记录患者的膝关节活动度、稳定性及Lysholm评分,比较术前及末次随访的Lysholm评分来评价盘状半月板成型缝合术的近期临床疗效。结果所有病例在末次随访时没有关节交锁及失稳症状,关节活动度均恢复正常。Lysholm评分从术前（58.8±6.8）分提高至术后（93.3±2.4）分,经t检验差异有统计学意义（t=-38.24,P〈0.01）。结论对于膝关节盘状半月板合并撕裂,在进行成型手术后通过Fast-fix及MM-Ⅱ对半月板撕裂进行缝合修复,可获得满意近期疗效。     

关节镜下半月板切除与缝合修补治疗半月板桶柄样撕裂的临床对比研究

目的 通过对比分析关节镜下缝合修补术和半月板次全/全切除术治疗半月板桶柄样撕裂的临床疗效,探讨缝合修补治疗半月板桶柄样撕裂的应用价值.方法 回顾性分析2005年1月至2009年1月经关节镜治疗的34例(34膝)半月板桶柄样撕裂患者,其中采用全内缝合或全内和外内联合缝合的患者15例(A组),男9例,女6例;平均年龄为(30.3±6.8)岁;受伤至手术时间平均为(10.6±3.8)d;内侧半月板损伤12例,外侧半月板损伤3例.同期采用半月板次全/全切除术19例(B组),男11例,女8例;平均年龄为(29.1±5.5)岁,受伤至手术时间平均为(10.2 ±2.8)d;内侧半月板损伤15例,外侧半月板损伤4例.记录两组的手术时间,并通过患者的症状、体征、关节活动度和Lysholm评分等比较两组患者疗效.结果 手术时间:A组为(71.3±8.8)min,B组为(45.7±9.4)min,差异有统计学意义(P<0.05).两组患者术后获12～24个月(平均17.2个月)随访.术后6个月关节活动度A组平均为138.7°±5.1°,B组平均为136.0°±4.6°;术后12个月关节活动度A组平均为140.1°±3.1°,B组平均为139.8°±3.3°,两组比较差异均无统计学意义(P>0.05).术后6个月Lysholm评分A组平均为(90.1±7.1)分,B组平均为(89.9±6.9)分,差异元统计学意义(P>0.05);术后12个月Lysholm评分A组平均为(94.5 ±3.9)分,B组平均为(90.3±5.8)分,差异有统计学意义(P<0.05),A组优于B组.结论 对于大型半月板撕裂,采用合适的缝合技术可使撕裂的全长段获得有效修补,能尽可能多地保留半月板的功能,临床疗效优于传统的半月板次全/全切除术.