射频汽化仪用于膝关节镜手术的临床初探

目的探索冷融化技术在膝关节镜手术中的应用前景和手术技术。方法采用 ArthroCare 2000汽化仪对 20例不同膝关节疾病患者施行关节镜手术。关节镜下诊断疾病分别为：半月板撕裂 6例,股骨髁关节软骨退变 6例,髌骨半脱位 5例,滑膜增生性炎症 2例,前十字韧带部分损伤 1例。通过汽化仪做膝关节镜下半月板部分切除、损伤软骨面及韧带修整、滑膜部分切除以及髌骨外侧支持带松解术等。结果术后膝关节无须加压包扎,分别于术后 24、 48及 72 h对术侧膝关节做浮髌试验检查,均为阴性。术后 24 h行 CPM锻炼,均无明显膝关节疼痛。患者自觉症状良好。镜下观察关节和半月板软骨处理面光整,无出血。结论 ArthroCare 2000汽化仪操作方便,治疗精确,在切除病损组织时最大限度地减少了邻近组织损伤,同时具有止血功能,有利于早期康复。     

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。     

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.     

射频气化技术在膝关节镜手术中的应用

目的 将射频气化低温切除技术用于膝关节镜手术中,观察其临床使用效果。方法 在膝关节镜手术主中使用射频气化仪对21例35部位进行了手术,包括有半月板切除、滑膜切除、软骨病灶清理、交叉韧带残端及髁间清理及术中止血等。结果 半月板切除手术更加快捷,尤其便于处理较为隐蔽已到达的后角处的损伤;软骨修整成形良好,对邻近正常软骨损伤小;对交叉韧带残端及髁间清理彻底;术中止血迅速有效。术后随访半年,临床效果良好。结论 射频气化具有良好的低温切除、止血作用,副损伤小,是关节镜手术进行切除与止血便捷有效的新方法。     

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。     

射频汽化仪关节镜下治疗膝关节及半月板病变的临床观察

[目的]观察关节镜下射频汽化治疗膝关节及半月板病变的临床疗效。[方法]收集2008²013年收治的膝关节及半月板损伤与病变263例,男181例,女82例,年龄172013年收治的膝关节及半月板损伤与病变263例,男181例,女82例,年龄17⁷3岁,平均(38±5.92)岁。其中半月板损伤176例,慢性滑膜炎35例(包括滑膜皱襞综合征6例),交叉韧带损伤26例,半月板松弛21例,慢性骨关节炎25例。以关节镜下射频汽化治疗,根据病变性质,利用不同汽化能量,分别采用半月板切割、固化软骨、平整关节面、消融增生组织、皱缩韧带等操作方法。于治疗前与治疗后1个月作Lysholm膝关节功能评分、Lequesae膝关节疗效判定,并作统计学处理。[结果]该组患者手术前与手术后1个月的Lysholm膝关节功能评分为(40.25±5.69)分和(86.67±7.32)分,P=0.001;Lequesae疗效判定的临床有效率为87.06%,P=0.000,均有统计学意义。[结论]关节镜下射频汽化治疗各种原因的膝关节、半月板及附属韧带和软骨病变创伤小、止血效果好、精确性高、操作方便、疗效确切,值得推广应用。     

关节镜下射频汽化技术治疗半月板损伤疗效观察

[目的]探讨关节镜下射频汽化技术治疗半月板损伤的临床疗效。[方法]对58例膝关节半月板损伤患者常规行关节镜检查,应用Arthrocare 2000射频汽化仪,先应用汽化钩,对损伤半月板不能保留部分进行切割、成形,对保留半月板边缘用汽化刷,均匀涂刷汽化,修整至平滑的楔面,使呈条丝状分离或松弛翘起半月板损伤部分紧缩和裂隙固定,并对出血点电凝止血。[结果]术后2 d行患膝屈伸功能锻炼,4周关节活动正常,平均随访2年,关节无肿胀及积血、疼痛、弹响、交锁症状消失。[结论]关节镜下应用射频汽化行半月板成形具有使半月板残缘修整成楔面及紧缩和裂隙固定功能,减少关节软骨磨损;并能术中止血,减少关节积液。     

膝关节镜治疗老年人盘状半月板损伤

目的探讨膝关节镜治疗老年人盘状半月板损伤的疗效。方法对19例外侧盘状半月板损伤的老年患者进行关节镜手术,依具体损伤情况采用半月板成形术15例,次全切除术2例,全切除术2例。同时对伴随的骨关节炎、关节游离体、内侧半月板损伤、滑膜皱襞增生给予切除增生滑膜、关节软骨修整、游离体取出及内侧损伤半月板次全切除。结果18例获得随访,时间6～24（15±9）个月,按Ikeuchi膝关节评分标准：优13例,良2例,可2例,差1例。结论膝关节镜下治疗老年人盘状半月板损伤可以获得良好的效果。     

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。     

Electrosurgical methods for arthroscopic meniscectomy

Purpose: To outline the development of electrosurgical (radiofrequency) devices, explain the basic principles, and review the current orthopaedic literature regarding the application of electrosurgery to arthroscopic partial meniscectomy. Materials and Methods: The history and principles of electrosurgery were obtained from various pertinent texts and journal articles. A literature search was performed using MEDLINE; reviewed articles consisted of articles in the English language cataloged between 1966 and January 1999. Results: The history and principles of electrosurgery are reviewed. The articles pertaining to arthroscopic electrosurgical meniscectomy are discussed with a separate discussion on the potential complications of using radiofrequency energy for meniscal ablation, including articular cartilage damage, osteonecrosis, and damage caused by irrigant. Conclusion: Electrosurgery has been shown to be an effective tool in arthroscopic meniscectomy. Further research and refinement is warranted because it may show superiority to other methods in certain situations.     

1310例侧膝关节半月板损伤关节镜下诊治效果分析

目的　分析关节镜下半月板损伤不同修复方法的效果 ,提出半月板损伤修复较适用方法。方法　随访 1310例侧膝关节半月板损伤镜下修复的患者 ,从发病年龄、损伤类型、镜下修复方法及效果进行分析 ,其中男性 880例 (90 9例侧 ) ,女性 374例 (4 0 1例侧 ) ,平均 2 5 5岁 ,平均患病时间半年。半月板缝合 6 8例侧 ,部分切除成形术 75 6例侧 ,半月板全切除 4 80例侧 ,6例儿童半月板损伤镜检确定后未行镜下处理 ,于镜检后石膏固定。结果　术后平均随访 4年 3个月 ,Lysholm评分 :半月板缝合术前 4 7 5分 ,术后 86 3分 ;半月板部分切除成形术前 4 5 1分 ,术后 84 0分 ;半月板全切除术前4 5 4分 ,术后 76 1分。 6例少年儿童半月板损伤 ,Lysholm评分术前 4 5 0分 ,术后 98 7分。三种治疗方法效果有显著性差异 (t=2 876 ,P <0 0 1)。结论　半月板损伤应在关节镜下行缝合或部分切除成形治疗 ,避免半月板切除 ;<14岁盘状半月板损伤需部分切除成形 ,半月板损伤非手术治疗可获得较好疗效     

Electrosurgical methods for arthroscopic meniscectomy: A review of the literature

Purpose: To outline the development of electrosurgical (radiofrequency) devices, explain the basic principles, and review the current orthopaedic literature regarding the application of electrosurgery to arthroscopic partial meniscectomy. Materials and Methods: The history and principles of electrosurgery were obtained from various pertinent texts and journal articles. A literature search was performed using MEDLINE; reviewed articles consisted of articles in the English language cataloged between 1966 and January 1999. Results: The history and principles of electrosurgery are reviewed. The articles pertaining to arthroscopic electrosurgical meniscectomy are discussed with a separate discussion on the potential complications of using radiofrequency energy for meniscal ablation, including articular cartilage damage, osteonecrosis, and damage caused by irrigant. Conclusion: Electrosurgery has been shown to be an effective tool in arthroscopic meniscectomy. Further research and refinement is warranted because it may show superiority to other methods in certain situations.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 8 (November-December), 2000: pp 813–821     

Endoscopic Partial and Total Meniscectomy: A Comparative Study with a Short Term Follow Up

The results of partial endoscopic meniscectomy in 89 patients were compared with the results of total endoscopic meniscectomy in 78 patients. Total meniscectomy was the more time consuming and there were intraoperative technical problems in 16 patients, the most common being rupture of the meniscus during extraction. All complications were, however, successfully handled and did not affect the end result. There were nine reoperations after partial and only one after total meniscectomy. The patients were followed up on the average 16 months after operation with a special knee function questionnaire. There was no difference between the groups in score distribution, indicating similar knee function. However, patients in the total meniscectomy group with a follow up longer than 1 year had significantly higher scores than those with a shorter follow up. No such difference was noted in the partial group, possibly indicating that the final level of knee function is reached earlier after partial than after total meniscectomy.     

Biomechanical study on contact pressure in the femoro-tibial joint

To clarify the function of the menisci, dynamic contact pressure in femoro-tibial joints obtained from postmortem or surgical specimens with intact menisci, following partial and total meniscectomy was measured using transistor pressure transducers and Buldon tube pressure gauges. After meniscectomy, the peak contact pressure increased strikingly and contact area decreased markedly. The lower contact pressure after partial meniscectomy than after total meniscectomy is probably one reason why the results of partial meniscectomy are clinically much better than those of total meniscectomy. With flexion of the knee, the region of peak contact pressure shifted posteriorly and high contact pressure was detected below the posterior segment of the medial meniscus. Stress release in articular cartilage varies from region to region, and occurs remarkably after meniscectomy. These findings suggest that the main function of the menisci is load bearing and protection of the cartilage from overload applied to the knee joint.     

Arthroscopic partial and total meniscectomy: A long-term follow-up study with matched controls

Purpose: The purpose of this study was to compare the clinical and radiographic outcome of arthroscopic partial and total meniscectomy. Type of Study: Retrospective outcome study. Methods: Thirty-six male patients with stable knees, no previous knee injury, and arthroscopic meniscectomy were matched into 2 groups: partial or total. In addition, a group of individuals with no known history of knee injury was matched to each patient with meniscectomy. All patients were re-examined by a clinical and radiographic examination 14 years after surgery. Results: At follow-up, radiographic changes, including Fairbank changes and joint space narrowing, were seen in 6 of 18 patients (33%) after partial meniscectomy and in 13 of 18 patients (72%) after total meniscectomy (P <.05). Joint space narrowing >50% of the joint space was seen in 1 patient after partial meniscectomy but was present in 7 patients after total meniscectomy. In the healthy controls, 4 of 36 patients (11%) had radiographic changes but none had joint space narrowing. Fourteen years after surgery almost 70% of patients had a Lysholm score >94 (i.e., normal). Only 5 of 36 patients (14%) in the total meniscectomy group had knee symptoms during activities of daily living. A similar decline in activity levels according to Tegner was seen over time in the control group and in the 2 meniscectomy groups. Conclusions: The frequency of radiographic changes 14 years after meniscectomy is related to the size of the meniscus removed, but the grades of these changes are low and have little influence on activity and knee function.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 2 (February), 2002: pp 183–189     

Meniscectomy

To review the meniscus from a historical perspective especially on surgical management and general guidelines for arthroscopic meniscectomy procedures for various types of meniscal tears. We searched MEDLINE and PubMed for the years of 1980-2010 using the terms meniscus, meniscal repair, menisectomy, and arthroscopy. Orthopedic surgeons frequently encounter patients with pain or functional impairment of the knee joint and repair or resection of the injured meniscus is one of the most common orthopedic operative procedures. The object of meniscal surgery is to reduce pain, restore functional meniscus and prevent the development of degenerative osteoarthritis in the involved knee. Historically, total meniscectomy was a common procedure performed for meniscus tear symptoms. However, it has been reported that total meniscectomy has deleterious effects on the knee. In the past, the menisci were thought as a functionless remnant tissue. Currently, it is known that the meniscus is an important structure for knee joint function. Menisci provide several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint. It is widely accepted that the function of the meniscus can be preserved through minimal excision. An arthroscopic partial meniscectomy preserving more of the meniscus is preferred over total meniscectomy. In recent decades, this shift toward arthroscopic partial meniscectomy has led to the development of new surgical techniques.     

Joint space narrowing after partial medial meniscectomy in the anterior cruciate ligament-intact knee

Osteoarthritis of the knee is common after total medial meniscectomy. In anterior cruciate ligament-intact knees, the reported outcomes of partial medial meniscectomy are variable. Radiographic assessment using a posteroanterior weight-bearing view is a reliable tool for detecting minor medial joint space narrowing, which may be an early sign of osteoarthritis. Studies that assessed the effect of partial medial meniscectomy found a low percentage of patients with >50% joint narrowing at 10 to 15 years after surgery. Digital radiography, using a posteroanterior weight-bearing view, is a highly sensitive method for observing minor joint space narrowing in the involved knee. A recent study showed that 88% of patients who underwent partial medial meniscectomy had joint space narrowing of <2 mm, and none had narrowing >or=2 mm, at a mean follow-up of 12 years. Subjective results after partial medial meniscectomy are favorable, with 88% to 95% of patients reporting good to excellent results.     

半月板不同切除术对髌股关节影响的生物力学研究

目的探讨半月板不同部位,不同程度切除后对膝关节髌股关节的影响,为半月板不同切除术的比较提供生物力学依据。方法采用6具人膝关节新鲜标本,保留内、外侧副韧带、关节囊及膝关市伸膝装置,Staubli机器人模拟生理状态下膝关节站立至下蹲屈膝过程,采用超低压型压敏片测量完整膝关节和半月板不同部化及程度切除术后不同屈膝角度下髌股关节接触面积、接触压,并用SPSS 12．0进行双因素方差分析。结果1．无论何种状念的半月板切除,其髌股关节接触的总体趋势没有改变,即膝火节心曲0°～90°髌股关节的接触面积会逐渐增加;2．半月板部分切除与正常膝关节在髌股接触面积、髌股平均接触从压力间的差异无统计学意义;3．外侧半月板全切除与正常膝关节在髌股接触面积之间的差异有统计学意义,其骸股接触面积在各个屈曲角度均小于正常膝关节,其髌股接触平均压力存各个屈曲角度均大于正常膝关节的髌股接触平均压力;4．内侧十月板全切除与正常膝关节在髌股接触面积间的差异无统计学意义,内侧半月板全切其在膝关节屈曲0°～30°之间其髌股关节平均压力均大于正常膝关节髌股关节间平均压力;60°～90°之间与正常膝关节髌股关节间平均压力间的差异无统计学意义。结论外侧半月板全切除术后髌股关节高接触压力、内侧半月板全切除术后髌股关节低接触压力及半月板部分切除术后髌股关节压力分布小均是术后髌股关节炎发生不可忽视的原因。