关节镜检查和镜下治疗膝关节急性损伤47例

目的 分析膝关节急性损伤早期关节镜检查和镜下治疗的价值。方法 对４７例膝关节急性损伤患者进行早期关节镜检查,其中２６例行关节镜下手术治疗。结果 ４７例关节镜检查患者,镜下除证实Ｘ线诊断外,另发现损伤２８处;２６例镜下治疗患者优良率８３．３％。结论 早期关节镜检查可全面评估损伤程度,提高诊断水平;镜下手术治疗具有创伤小、并发症少、功能恢复快以及总体疗效好等优点。     

椎间盘镜辅助下微创取异物16例报道

自 2 0 0 0年 1月～ 2 0 0 4年 2月 ,采用椎间盘镜辅助下摘除体内深部组织异物存留 16例 ,效果满意 ,报告如下 :1　临床资料1.1　一般资料本组 16例 ,男 11例 ,女 5例 ;年龄 14～ 64岁。本组病例中枪弹伤后弹片存留体内深部组织 10例 ,其它意外伤致金属异物存留 6例。 16例中异     

膝关节镜下治疗膝关节粘连

目的探讨关节镜微创手术治疗膝关节粘连的方法和疗效。方法21例膝关节粘连患者,年龄17-57岁,平均34.8岁。在关节镜下松解髌上囊、髁间窝及双侧隐窝的粘连,膝关节外上小切口行股中间肌切断术,术后第3天开始功能锻炼。结果随访6个月-3年,平均1.8年。疗效评定按Judet疗效评定法,优17例,良3例,可1例。平均较术前改善70.5°。除1例患者切口愈合不良经换药于术后4周愈合外,所有病例未出现伤口感染和皮肤坏死等并发症。结论关节镜下微创手术治疗膝关节粘连具有伤口小、创伤小、术后疼痛轻、并发症少、康复快等优点,是治疗膝关节粘连的有效方法。     

严重膝关节伸直挛缩的微创治疗

目的介绍一种治疗严重膝关节伸直挛缩的微创手术方法,探讨其临床疗效。方法1998年9月至2001年10月,共手术治疗22例膝关节伸直挛缩患者,手术包括小切口股四头肌成形术和关节镜清理术两部分。首先通过髌骨外上方的小切口行股四头肌成形术,逐步解除阻碍膝关节屈曲的关节内和关节外因素。在此基础上,再行关节镜下清理术。术后第1d即开始行功能锻炼。结果术后随访14￣63个月,平均42个月。22例患者中16例重度伸直挛缩患者行股四头肌肌腱延长术。膝关节屈曲由术前的平均27°(5°￣45°)增加到术后即刻的141°(120°￣150°);伸膝缺失由术前的平均0.9°(0°￣10°)减少到术后即刻的0.45°(0°￣5°)。随访结束时本组平均屈曲度为115°(75°￣150°),增加88°(45°￣125°),与术前相比差异有统计学意义(t=-19.317,P<0.01),平均伸膝缺失为1.1°(0°￣15°),增加0.2°。按照Judet标准,优16例,良5例,可1例。手术前后平均HSS膝关节功能评分分别为74分和94分。有1例患者切口发生浅表感染,另1例存在15°永久性伸膝缺失。结论该方法适用于大多数膝关节伸直型挛缩畸形,具有创伤小、并发症少、操作简单和疗效可靠等优点。它提供了一种全新的、能够替代传统方法的治疗手段。     

膝关节镜手术并发症临床分析

1997年1月～2005年12月,我院对324例膝关节疾病患者行关节镜手术治疗,其中23例出现各种并发症。笔者总结分析其产生原因并提出防治措施。     

2000ArthroCare System在膝关节镜手术中的应用

目的探讨冷融化技术在膝关节镜手术中方法和前景。方法采用2000ArthroCare System(2000ACS)对221例膝关节病实施手术治疗。关节镜下疾病诊断：骨性关节炎73例，半月板损伤49例，关节软骨软化症29例，滑膜皱襞综合征15例，盘状半月板13例，滑膜炎11例，大骨节病11例，ACL 8例，剥脱性骨软骨炎5例，关节粘连5例，TKA术后松解2例。通过2000ACS做关节镜下的半月板切除、成形，软骨面及韧带修整，滑膜切除，髌外侧支持带松解术等。结果按Lysholm评分，术前平均43．92，术后3个月81．96，术后6个月92．06。结论关节镜2000ACS治疗关节疾病，操作安全，疗效可靠，痛苦少，有利于早期功能锻炼。     

膝关节镜下治疗盘状半月板损伤

目的观察膝关节镜下手术治疗膝关节盘状半月板损伤的疗效。方法1999年7月～2003年6月,行膝关节镜下外侧盘状半月板成形术45例49膝(41例单侧,4例双侧),其中完全型32膝,不完全型17膝。常规关节镜检查,根据盘状半月板损伤状况,实施关节镜下盘状半月板部分切除术44膝(其中3膝同时做半月板缝合术)、盘状半月板全切除术5膝。术后早期开始肌力训练和关节活动练习。结果本组45例手术全部成功,无手术并发症。40例获1年8个月～5年7个月(平均3年3个月)的随访。根据Lysholm-Ⅱ评分系统做术前及随访时膝关节功能评定,术前评分平均55分(40～71分),随访时评分平均88分(60～100分),优良率为85.3%。结论膝关节镜下盘状半月板成形术是治疗盘状半月板损伤的最好方法之一,手术损伤小,恢复快,并发症少,可最大限度保存半月板结构和功能。配合正规的康复训练,可获得良好疗效。     

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。     

膝关节镜的计算机图像处理系统

目的 介绍膝关节镜手术资料计算机采集，编辑，管理，保存的方法和经验。方法 利用视 卡实现计算机对关节镜动静态图像的采集，应用计算机各种软件完成对各种图像的编辑，管理，应用可写光盘永久保存。结果 计算机采集图像分辨率高，编辑，管理方便，打印照片清晰资料可永久保存。结论多媒体计算机的应用为关节镜图像资料的处理提供了一种快捷，简便，可靠的方法。     

射频气化仪用于40例镜下膝关节清理术

我院于2002年2-7月将射频气化仪(美国Arthro Care公司)应用于40例镜下膝关节清理术,获得良好疗效. 　　1 临床资料 　　本组40例,男14例,女26例;年龄45～62岁.关节镜下诊断为:股骨髁软骨退变25例,半月板损伤8例,内侧滑漠皱襞综合征5例,部分前交叉韧带损伤2例.……     

Intra-articular foreign body after arthroscopy

We report a case of a small metal fragment that dissociated from an arthroscopic instrument and remained inside the knee joint for 14 months, causing recurrent swelling and pain. For safety reasons, arthroscopic instruments should be checked carefully at the end of surgical procedures because the loss of the fragment was not obvious and the device was still functioning. To our knowledge, this is the first case of an undetected foreign body iatrogenically introduced into a joint by arthroscopy.     

Pseudoaneurysm complicating knee arthroscopy. A case report

Pseudoaneurysm formation is a rare complication after knee arthroscopy. Most pseudoaneurysms complicating knee arthroscopy develop on the popliteal and geniculate arteries. We report a case of a pseudoaneurysm developed on an arterial branch to the medial gastrocnemius muscle, as a complication of an arthroscopic meniscectomy in a 66-year-old patient. The patient was treated successfully by resection of the pseudoaneurysm and ligation of the injured artery.     

膝关节镜下的修复与重建

自 2 0世纪 6 0年代日本Watanobe发明膝关节镜以来 ,随着关节镜技术的广泛开展及光电技术的进步 ,不仅关节镜及其操作系统不断改进 ,镜下手术的模式也由切除病灶向修复重建转变。关节镜应用比以往更强调尽可能少地切除组织 ,而转向各种修复、移植、重建等关节镜下手术的理论与技术的研究。近年来 ,膝关节镜外科中最活跃的研究课题便是半月板修复与移植、膝前交叉韧带(anteriorcruciateligament,ACL) /膝后交叉韧带 (posteriorcruciateligament,PCL)的重建、关节软骨缺损的修复与再生、异体组织移植等。笔者就常见膝关节疾病膝关节镜下的…     

Open removal of pediatric airway foreign body: A case report and literature review

BackgroundForeign Body Aspiration is a common finding in children diagnosed based on clinical signs and radiological studies so that timely diagnosis and successful removal of the foreign body is essential to reduce complications and mortality.Case presentationIn this study, we described a case of a 7-year old boy with a foreign airway body whose bronchoscopy was not successful in removing the foreign body, and the removal required open surgery. We also review the literature on Pediatric airway foreign bodies.DiscussionThe patient was discharged in good condition after being monitored and receiving antibiotics in the pediatric ward for seven days.ConclusionRigid bronchoscopy involves fewer complications and is more successful in removing the foreign body in children. However, a small percentage of children require open surgery for removal, which can be attributed to the size of the FB, its shape, how long the FB stays in the airways, and the changes that follow are involved and sufficient expertise in rigid bronchoscopy.     

Patients' recollection of day case knee arthroscopy procedure

A prospective study of 103 consecutive patients who underwent day case knee arthroscopy was performed. The purpose was to evaluate the information delivery system, patient comprehension, and issues of informed consent pertaining to day case arthroscopy procedures. There were 34 females and 69 males in the study group and their mean age was 38.6 years (range: 14.4 to 74.9 years). The diagnosis, procedure, and aftercare were explained to the patients in the outpatients clinic by a trained nurse and by the operating surgeon just prior to the operation. The nurse before the operation gave the patients an information booklet. Postoperatively the patients were informed about the findings and diagnosis prior to their discharge from the day care facility. Patients were requested to complete a questionnaire. Three weeks later they were given the same questionnaire, prior to consultation, in the outpatient clinic. These two forms were compared with the operative findings and diagnosis documented in the copy, of the questionnaire completed by the surgeon as well as the case notes. Most patients (38.8%; 40 patients) had no recollection; 3.9% (4 patients) had partial recollection at their consultation three weeks later; 19.4% (20 patients) found that the arthroscopic photograph was not helpful in making them understand the procedure; and 9.7% (10 patients) found the information booklet to be unhelpful. Further, 23.3% (24 patients) said that it would not help if the booklet were sent to them prior to the operation. The recollection rate was also correlated to their position on the operating list, to ascertain the effect of the anesthetic. There was a 65.9% (58 patients) recollection rate in those patients who were on the first half of the list and there was only a 33.33% recollection rate in those patients who were last or second to the last [p = 0.0225]. We recommend regular evaluation and improvement in the communication and information delivery system provided to patients.     

应用关节镜诊治运动性膝关节损伤

随着关节镜技术的发展,对膝关节损伤的诊断与治疗有了长足的进步。2004年5月-2010年7月,我们对17例运动性膝关节损伤患者采用膝关节镜诊治,临床效果满意,报道如下。     

Outpatient arthroscopy of the knee under local anaesthesia

Summary Arthroscopy of the knee was carried out under local anaesthesia in 313 outpatients, with arthroscopic surgery in 81. The procedure had to be abandoned because of apprehension in only 0.9%. With increasing experience, the number of arthroscopic meniscectomies increased from 5% to 64% of the lesions found. The method was particularly valuable in the assessment of patello-femoral pain since dynamic evaluation of patellar alignment, and the localisation of sensitive structures by palpation, was possible. The method is a safe, reliable and inexpensive alternative to the use of spinal or general anaesthesia for arthroscopy.

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Résumé Une arthroscopie du genou a été pratiquée sous anesthésie locale chez 313 malades externes. Quatre-vingt-un ont bénéficié d'une chirurgie sous arthroscopie. Le procédé a dû être abandonné en raison de l'appréhension chez seulement 0.9% d'entre eux. Avec une expérience accrue, le nombre des méniscectomies sous arthroscopie est passé de 5 à 64% des lésions découvertes. La méthode a été particulièrement valable dans l'évaluation de la douleur fémoro-patellaire. Une étude dynamique de l'alignement rotulien et la localisation des structures douloureuses par palpation a été possible. La méthode est sûre et fiable. C'est une alternative peu coûteuse à l'utilisation de l'anesthésie rachidienne ou générale.