射频汽化仪在关节镜下治疗膝盘状软骨损伤中的应用

目的探讨射频汽化仪在关节镜下治疗膝关节盘状软骨损伤中的应用及与常规器械治疗比较。方法回顾分析1993年3月～2003年12月期间资料完整的248例膝关节盘状软骨损伤,比较射频汽化仪(R F)组和常规器械(C I)组的手术时间、术后关节积液和膝关节功能恢复程度。结果R F组比C I组的手术时间明显缩短,差异有极显著意义(P<0.01);术后关节积液量和术后膝关节功能恢复程度,R F组均优于C I组(P<0.05)。结论使用射频汽化仪在关节镜下行膝盘状软骨切除成形术具有操作简便、成形满意度高、安全、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.     

射频汽化仪在关节镜下治疗膝关节疾病中的应用

目的探讨射频汽化仪在关节镜下治疗膝关节疾病的疗效。方法采用Arthrocare 2000射频汽化仪对126例膝关节疾病进行关节镜手术，其中半月板损伤72例，滑膜炎20例，骨性关节炎15例，髌骨半脱位8例，滑膜皱襞综合征6例，前交叉韧带部分损伤5例。结果126例术后3个月均获随访，无一例切口或关节感染。术后3个月膝关节功能按Neer评分标准：优82例，良35例，可9例，差0例。优良率92．9％。结论使用射频汽化仪在关节镜下治疗膝关节疾病能使手术简便且精确，有效地止血，创伤小，同时能减少对邻近组织的损伤，术后膝关节功能恢复良好。     

射频汽化仪在膝关节镜手术中的应用

目的探讨射频汽化仪在膝关节镜手术中的应用及其疗效。方法利用射频汽化仪对78例不同膝关节疾病患者进行关节镜手术,其中半月板部分切除18例,全切除7例,盘状半月板成形13例,损伤软骨及韧带修整21例,滑膜切除6例,髌骨外侧支持带松解5例,胫骨髁间隆突骨折固定6例,前交叉韧带重建2例。结果术后患侧膝关节肿胀轻,未见明显关节积液、积血。随访3～12个月,75例患者自觉症状良好,关节绞锁、疼痛等症状缓解;3例重度骨性关节炎者症状无缓解,转行人工关节置换术。膝关节功能评定：优46例,良29例,可0例,差3例,优良率96．2％。结论射频汽化仪具有良好的低温切除、止血作用,使用方便,有助于提高膝关节镜手术的效率及疗效。     

射频汽化仪在前交叉韧带重建中的应用

目的: 探讨射频汽化仪在前交叉韧带重建中的应用。方法: 2001年 3月 ~2003年 3月, 在膝关节镜下利用自体骨-髌腱-骨复合体重建ACL30例。利用射频汽化仪在前交叉韧带重建中切除滑膜, 软组织清理, 髁间窝成形, 前交叉韧带紧缩。结果: 随访 1 ~3年,(平均 17个月), 关节活动度正常。Lysholim评分从术前平均 52分提高到 83分。膝关节主观与客观稳定性均明显改善。结论: 对功能不稳的ACL进行自体髌腱中 1 /3重建, 关节镜下骨道定位准确, 移植物固定牢固。同时应用射频汽化仪, 可以同时处理关节内合并损伤, 手术快, 出血少, 创伤减轻, 术后恢复快, 明显提高手术治疗效果。     

关节镜下射频汽化仪治疗膝外侧盘状半月板损伤

人类膝关节外侧半月板为新月状。盘状或环状均视为异常。文献报道，东方人盘状半月板的发生率为15％左右，其中绝大多数发生在外侧，内侧罕见。损伤后将引起一系列的症状及相应改变。以前多采用直视下半月板切除术，但术后易引起膝关节内非生理状态下早期关节功能退变的发生。1982年Ikeuehi首先报道盘状半月板镜下切除术，近年来该手术逐渐为人们所接受。而射频汽化仪结合镜下盘状半月板成形术，由于疗效确切受到医患人员的肯定。     

射频汽化仪在关节镜下治疗半月板损伤和腘窝囊肿的应用

目的评价射频汽化仪在关节镜下治疗半月板损伤和腘窝囊肿的效果。方法在2003年10月～2006年5月利用Authrocare 2000射频汽化仪对41例半月板损伤（其中合并腘窝囊肿5例）患者进行关节镜手术治疗,其中部分切除成形38例,全切除3例。按Lysholm膝关节功能评分标准,术前36.8±4.5。结果41例患者均经9～18个月的随访,随访时膝关节功能评分为85.4±5.2分,较术前明显提高,且差异有统计学意义（P〈0.001）。结论Authrocare 2000射频汽化仪在关节镜下治疗半月板损伤效果良好,具有低温冷凝、汽化、切割及止血功能,使得手术操作简便易行,组织创伤小,副反应轻,利于早期功能恢复。     

关节镜下射频汽化仪治疗髌股关节紊乱症

目的 探讨关节镜下应用射频汽化仪治疗髌股关节紊乱症的方法与疗效.方法 2004年6月-2007年6月,收治86例98膝髌股关节紊乱症患者.男30例34膝,女56例64膝;年龄15～68岁,中位年龄40岁.左膝42例,右膝32例,双膝12例.病程3个月～6年,平均30.5个月.静力性髌骨外侧倾斜28膝,外侧半脱位10膝;动力性髌骨外侧倾斜45膝,外侧半脱位15膝.术前Lysholm膝关节功能评分(57.72±8.86)分.术中采用关节镜下射频汽化仪行外侧支持带松解术或辅以内侧支持带紧缩术,同时对病变软骨行双极射频软骨成形术.结果 髌股关节面软骨病变按Outerbridge分级:Ⅰ级18膝,Ⅱ级36膝,Ⅲ级32膝,Ⅳ级12膝.术后患者切口均Ⅰ期愈合,无关节内积血及关节腔感染等并发症发生.75例82膝获随访,随访时间为8～37个月,平均20.6个月.术后1个月患者膝前痛症状明显缓解,关节活动度良好,动力位及静力位髌骨轴位X线片未见髌骨外侧倾斜或半脱位.术后6个月Lysholm评分为(69.95±5.42)分,与术前比较差异有统计学意义(P<0.05).按照软骨分级进行Lysholm评分,除Ⅳ级与术前比较差异无统计学意义(P>0.05),Ⅰ、Ⅱ、Ⅲ级患膝与术前比较差异均有统计学意义(P<0.05).结论 关节镜下采用射频汽化仪行软组织平衡术和软骨成形术具有操作简便、创伤小、出血少、术后反应轻等优点,是一种治疗髌股关节紊乱症的有效方法.     

射频汽化仪在踝关节镜手术中的应用

射频汽化仪运用于踝关节镜诊断治疗,是一种新的而且疗效显著的手术方法。该仪器可在低温下行关节内组织切割、汽化、修整、紧缩、止血等处理。本院自2000年6月以来,在踝关节镜监视下通过射频汽化仪汽化已进行踝关节创伤性关节炎关节清理19例,手术效果满意。现报道如下。1临床资料1.1一般资料:本组男11例,女8例;年龄19～68岁,平均43.5岁;左10例,右9例,均为单侧;病程最长6年,最短6个月,平均3.3年。早期踝关节损伤按Lauge-Hansen分型:A型(旋后内收型)7例,B型(旋后外旋型)7例,C型(旋前外展型)3例,D型(旋前外旋型)2例。除2例D型损伤外,余X线…     

盘状软骨的关节镜下治疗及临床特点

目的 总结盘状软骨的关节镜下治疗的方法和疗效及临床特点，为日后更好的诊治盘状半月板提供依据。方法 31例（31膝）盘状软骨患者分别采用关节镜下成形术27例和全切术3例、1例边缘撕裂成形后缝合修补术。结果 按Ikeuchi氏膝关节评价等级评定疗效；优17例（54．8％），良11例（35．5％），可3例（9．7％）。3例术后自述有弹响，查体见其中2例有外侧半月残留部不稳的体征。结论 盘状软骨在膝关节屈伸运动中所产生的非生理性运动，易造成盘状软骨的破裂、关节软骨磨损以至关节软骨早期出现退行性改变等，症状性盘状软骨一旦发现，无论破裂与否均应早期手术。关节镜下盘状软骨成形术可获得优良疗效。盘状软骨引发的弹响交锁有其特征性临床特点；MRI对盘状软骨诊断有确认意义。     

Microfracture for treatment of cartilage detects

Subchondral bone plate microfracture technique (Steadman) has shown to enhance chondral resurfacing by providing a suitable environment for tissue regeneration and taking advantage of the body's own healing potential. Microfracture technique belongs to the bone marrow stimulating methods like abrasion arthroplasty or subchondral bone drilling. Using a specially designed awl or pick, multiple perforations ("microfractures") are placed 3 to 4 mm apart and about 4 mm deep into the subchondral bone to reach a zone of vascularization. The formation of a fibrin clot ("super clot") containing the desired pluripotential stem cells is stimulated. This clot then differentiates and remodels, resulting in a durable fibrocartilage repair tissue. The arthroscopic awls produce essentially no thermal necrosis of the bone compared to hand-driven or motorized drills. In contrary to drills, it is possible with differently curved awls to reach and treat every area of the knee joint or even of the upper ankle or shoulder joint. Between 1992 and 1998 this technique has been used in 351 cases. 162 patients were interviewed with a questionnaire with respect to their subjective judgement of health between 3 and 6 years (mean 4.4) after operation. Pain was the parameter with the greatest improvement. 78% of the patients improved, 18% remained unchanged and 4% were worse. Microfracture is an advisable option for the treatment of full thickness chondral defects.     

Use of cartilage graft for an orbital socket implant

After enucleation, a spherical implant of some material is placed into the muscle cone to give bulk to the orbital socket area. This also allows better movement of the artificial eye prosthesis, which is placed in the socket to give the appearance of a normal eye. If there is loss of the spherical implant because of infection or extrusion for other reasons, there is a resulting enophthalmos of the prosthetic eye. Replacement of this spherical implant with another implant of alloplastic material often results in secondary extrusion. In other cases, there is downward displacement of the spherical implant with pressure against the prosthesis and lower lid. This causes undue stretching of the lower fornix and lid area with inability to hold the prosthesis in place. To correct these two problems, we have found that an autogenous cartilage graft is useful for an implant that will not extrude and that holds its position. Examples of this technique and preoperative and postoperative cases are described here. We have used this technique over the past 11 years and have achieved good success in 15 patients.     

微骨折术修复关节软骨缺损

[目的]探讨关节镜下微骨折术修复膝关节全层软骨缺损的疗效。[方法]对2001年3月~2008年5月收治的膝关节软骨全层缺损的35例患者进行回顾性分析;平均随访(25.3±6.5)个月(16~53个月)。其中,剥脱骨软骨炎12例,外伤性骨软骨骨折20例,自发性骨坏死1例,继发性骨坏死2例。采用公认的功能评分系统,软骨MR I扫描和主观评分作为疗效判定标准。[结果]微骨折技术修复膝关节软骨全层缺损的总有效率为85.7%,其中疗效优19个膝关节,占54.3%,良11个膝关节,占31.4%,差5个膝关节,占14.3%。33例接受MR I检查,其中19例显示缺损软骨修复充填好,占57.6%,充填中等11例,占33.3%,充填差3例,占9.1%,平均Tegner评分从1.5±1.1提高到5.1±1.2(P0.01);Lysholm平均评分由42.3±11.3提高到85.5±12.1(P0.01)。[结论]微骨折技术是一项可供选择的实用有效修复膝关节软骨缺损的完全在关节镜下操作的微创技术;软骨修复充填程度与关节功能恢复密切相关。     

Surgical alternatives for treatment of articular cartilage lesions

Articular cartilage injuries in the knee are common; fortunately, full-thickness articular cartilage defects constitute only a small portion of this group. These lesions may be incidentally encountered during ligament or meniscal surgery, having been silent or asymptomatic for an unknown period of time. However, when they are large and symptomatic, the surgeon may choose from a wide array of techniques available for treatment. The relatively small number of natural history studies regarding full-thickness articular surface lesions complicates the decision-making process. Accurate evaluation and classification of the anatomic defect aids in the development of a clinical algorithm for treatment. Surgical techniques are either reparative or restorative in nature. Reparative techniques fall short of complete reestablishment of the articular cartilage; however, the resultant repairs may remain quite functional for varying periods of time. Restorative techniques attempt to reestablish the native articular surface. To date, no peer-reviewed, prospective, randomized, controlled studies of operative versus nonoperative treatment for full-thickness articular cartilage lesions have been published. Even though the long-term results of surgical treatment for full-thickness articular surface lesions remain unknown, the early results are encouraging.     

Use of cartilage grafts for closure of cleft palate fistulae.

We describe the results of using a free cartilage graft in the closure of cleft palate fistulae in 14 patients with a mean follow-up of 8.6 months. Complete closure of the fistula was achieved in 11 patients (79%), with partial closure in the remaining three patients. This technique is simple, causes relatively little discomfort, involves little tissue dissection and can be performed as a day-case procedure. The success rate is comparable with or better than other methods, and we consider it the treatment of choice for small cleft palate fistulae.     

Approach to cartilage lesions and algorithm for treatment

Cartilage symptoms in the knee may be encountered in various forms in orthopedic practice. The first stage from history to treatment is to establish the diagnosis; if the diagnosis is made as a cartilage lesion in the knee, priority must be given to current treatment approaches. The surgeon must provide information regarding etiology, defect thickness, lesion size, the containment of cartilage, localization, stability, meniscal integrity, anatomic alignment of the knee, previous assessments, radiological assessment (direct radiography, magnetic resonance imaging), and general, medical, and systemic conditions, and family history. In this review, a treatment algorithm is presented for the management of articular cartilage lesions.     

腕关节骨间韧带射频紧缩术对韧带形态及生物力学特性的影响

目的 探讨射频紧缩对腕关节骨间韧带解剖形态和生物力学性能的影响. 方法以新鲜冷冻成年男性腕关节标本为材料,对其腕骨间韧带进行射频紧缩治疗.分别在射频处理前、后观察和测量舟月掌、背侧韧带(SL-v,SL-d)、月三角背侧韧带(LT)、小多角骨-头状骨背侧韧带(TC)、头钩背侧韧带(CH)以及第2腕掌关节背侧韧带(CMC-2)的长度和厚度,并用生物力学试验机对射频处理后的韧带进行拉伸力学测定,分别记录断裂强度和断裂形变,对所测数据进行统计学分析.结果腕骨间韧带经射频处理后,韧带的长度都有不同程度的缩短,但仅有CH差异有统计学意义(t=-2.898,P=0.016);韧带均有增厚,其中SL-v,sL-d,LT,CH和CMC-2差异均有统计学意义(t值分别为-7.617,-2.241,-4.559,-3.971,-7.883,P<0.05).韧带的断裂强度有所增强,仅SL-d差异有统计学意义(t=-4.481,P=0.001),所有韧带的断裂形变都有显著性地增加. 结论 经射频处理的正常腕关节骨间韧带基本保持了原有的解剖形态,但韧带的厚度和粘弹性得到了显著地增强.