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。     

半月板全切除术远期疗效及其影响因素观察

本文对73例半月板全切除术患者的远期疗效及其影响因素进行随访观察,随诊时间10～34年,平均19.4年,主观满意者54.8％.结合物理检查和X线检查综合评定结果满意者52.1％。统计学分析表明远期疗效与患者手术时年龄、术前病程及半月板切除侧别有显著相关性。客观检查手术膝退行性变80.8％。作者认为半月板全切除术井非良性术式。     

半月板全切除术远期疗效及其影响因素观察

本文对７３例半月板全切除术患者的远期疗效及其影响因素进行随访观察，随诊时间１０￣３４年，平均１９．４年，主观满意者５４．８％，结合物理检查和Ｘ线检查综合评定结果满意者５２．１％。统计学分析表明远期疗效与患者手术时年龄、术前病程及半月板切除侧别有显著相关性。客观检查手术膝退行性变８０．８％。作者认为半月板全切除术并非良性术式。     

关节镜下治疗膝关节外侧盘状半月板损伤的临床疗效

目的探讨关节镜下治疗膝关节外侧盘状半月板损伤的方法及近期疗效。方法 2010年1月-2011年5月,收治38例(42膝)外侧盘状半月板损伤患者。男23例(24膝),女15例(18膝);年龄7～62岁,中位年龄32.8岁。病程7 d～40年,中位病程8.6个月。根据Watanabe盘状半月板分型标准,完全型22膝,不完全型19膝,Wrisberg型1膝。于关节镜下行半月板成形联合缝合术25例(28膝),半月板次全切除术12例(13膝),半月板全切除术1例(1膝)。术后早期开始肌力训练和关节活动练习。结果术后切口均Ⅰ期愈合。患者3～4周基本恢复正常活动。38例均获随访,随访时间12～18个月,平均14.3个月。无关节交锁及弹响症状;未出现再撕裂或因症状复发再手术的患者。术后3、6个月及1年膝关节屈曲及伸直活动范围均较术前显著改善(P<0.05);术后1年手术疗效按照Ikeuchi的评价方法,获优22膝,良16膝,可4膝,优良率为90.4%。术前及术后即刻、3、6个月、1年的Lysholm评分分别为(69.38±4.59)、(88.57±2.95)、(91.02±4.17)、(92.90±3.36)、(94.74±3.52)分,术后各时间点评分均较术前显著改善(P<0.05)。结论关节镜下治疗外侧盘状半月板损伤创伤小,能够精确切除或缝合失稳及破裂的半月板,最大限度保留半月板功能,延缓膝关节退变,术后配合正规康复训练可获得良好近期疗效。     

盘状半月板水平撕裂的手术治疗

[目的]探讨半月板成型术治疗盘状半月板水平撕裂的效果及手术方法。[方法]2002年12月~2006年8月,27人(膝)盘状半月板水平撕裂患者经关节镜行盘状半月板成型术。患者年龄6~42岁,平均32岁,男23例,女4例。关节镜探查后,首先切除半月板中央部约1/3的半月板组织,然后对半月板进行仔细评价。不稳定的一片切除至边缘,稳定的一片保留并且行半月板成型术,不能保留的则完全切除。术前及术后患者随访时行膝关节功能评分,并观察术后半月板再撕裂的可能性和再次手术的需求。[结果]患者术后随访3~36个月,平均随访8个月。Lysholm关节功能评分术前65~79分,平均(72·48±4·64)分,术后83~98分,平均(92·18±4·52)分。术后患者功能评分较术前提高,没有发现再撕裂和需要再次手术治疗的患者。[结论]半月板成型术应用于盘状半月板水平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。     

关节镜下外侧半月板全切和部分切除的短期疗效比较

目的比较关节镜下不同术式治疗外侧半月板损伤的短期疗效。方法210例(210膝)外侧半月板损伤在关节镜下行外侧半月板全切除或部分切除术,其中全切组120膝,平均年龄46.2岁(16～69岁);部分切除组90膝,平均年龄47.1岁(14～78岁)。Lysholm膝关节评分系统评价治疗效果并作手术前后的组间比较。结果术后获12～44个月(平均32.3个月)随访,Lysholm评分分别从术前的(56.2±16.6)分和(58.5±17.8)分提高至随访时的(92.9±10.3)分和(93.2±8.9)分,手术前后功能差异均有统计学意义(P<0.01),术后功能优良率达到96.67%和98.89%。两组患者间手术前后的Lysholm评分比较则均无统计学差异(P>0.05)。结论关节镜下治疗外侧半月板损伤是一种安全有效的方法,外侧半月板全切除术和部分切除术的短期治疗效果没有差异。     

膝关节镜治疗半月板损伤10年回顾

目的：探讨膝关节半月板损伤的临床特点及关节镜诊疗技术。方法：回顾1991年6月～2001年6月应用关节镜治疗、50岁以下患者半月板损伤378例，统计患者性别、年龄、职业、损伤侧别、损伤类型、治疗方法。术前及术后1年用Lysholm-Ⅱ评分评定膝关节功能。结果：261例半月板损伤获得随访，半月板部分切除组：103例，优良率79．67％，半月板全切组62例，优良率76．39％，半月板缝合组56例，优良率84．85％。结论：膝关节半月板损伤多发生在青年男性，外侧半月板病损率远远高于内侧半月板，关节镜下半月板损伤的治疗应针对不同损伤类型采取不同治疗方法，尽可能保留半月板。     

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。     

半月板切除对下肢力线的影响

目的探讨半月板切除后下肢力线的改变情况。方法自2000年6月至2004年3月,以术前诊断为半月板损伤且站立时膝关节能伸直的45例膝关节镜手术患者作为研究对象。男28例,女17例;年龄15～42岁,平均27.5岁。经膝关节镜证实,内侧半月板损伤6例,外侧半月板损伤21例,外侧盘状半月板12例,滑膜皱襞综合征、髌下脂肪垫增生症但半月板正常者6例。行半月板部分切除22例,半月板次全切除10例,半月板全切除7例。所有患者分别于手术前后拍摄双下肢全长负重位X线片,测量下肢力线,以膝关节中心到髋关节、踝关节中心连线的距离作为固有偏距(intrinsicvarizingdistance,IVD)。以手术前后IVD差的绝对值ΔIVD为参数,比较不同半月板切除量、不同半月板损伤情况、手术前后下肢力线改变程度之间的关系。结果随着半月板切除量的增加,下肢力线的改变程度也相应增加。半月板全切除组及次全切除组下肢力线的改变程度与半月板部分切除组和未切除组之间差异有统计学意义(P<0.01)。外侧盘状半月板切除后下肢力线的改变程度明显大于单纯外侧半月板切除者,差异有统计学意义(P<0.05)。结论半月板全切除、次全切除后,膝关节承受及传导截荷能力的变化主要表现为下肢力线的改变和膝关节内、外翻,外侧盘状半月板切除后膝关节外翻增加更为明显。术中应尽量修复损伤的半月板,对于需行半月板全切除、次全切除者,为避免下肢力线改变应尽早行同种异体半月板、组织工程半月板替代物移植,防止关节软骨发生退变。     

半月板切除术后膝关节晚期退行性变

对于半月板和切除术后膝关节晚期退行性发迹及其影响因素尚存在不少争论。本文报告了对４５例行半月板切除术患者１０－３３年的随访结果，有４０名可在Ｘ线平片上观察到地性发迹之表现，占８９％。统计学分析表明，膝关节退行性发迹与随访时间有关，外侧半月板切除较内侧半月板切除更易发生退变。     

Juxta-articular bone marrow signal changes on magnetic resonance imaging following arthroscopic meniscectomy

Purpose: Postmeniscectomy osteonecrosis of the knee has been reported in the past decade but the etiology remains unclear. Some investigators have indicated that bone marrow signal changes evident on magnetic resonance imaging (MRI) could be early warning signs of osteonecrosis. The purpose of this study was to determine the incidence rate, location, and magnitude of such changes in bone marrow of the knee after arthroscopic meniscectomy, using MRI. Type of Study: Cohort analytic study. Methods: Ninety-three patients with no bone marrow signal abnormalities on preoperative MRI were examined after isolated arthroscopic meniscectomy. There were 51 men and 42 women with an age range of 11 to 62 years (mean, 36.6 years). Of the total, 57 patients underwent partial meniscectomy (34 medial and 23 lateral) and the others total meniscectomy (10 medial and 26 lateral). MRI examinations were performed independently of postoperative knee symptoms, 1 to 24 months after surgery. Bone marrow changes of the treated knees were evaluated by T1- and T2*-weighted MRI. Results: Thirty-two of 93 patients (34%) had bone marrow signal changes in femoral or tibial condyles shown on postoperative MRI. No patients had these changes in the femoral or tibial condyles opposite from the meniscectomy side and, in the majority of cases, the size was less than half that of the condyle. Fifteen of the 44 patients who underwent medial meniscectomy and 17 of the 49 patients who underwent lateral meniscectomy had such changes. The meniscectomy side did not affect the incidence rate, and frequently both femoral and tibial condyles were involved. Age, gender and articular cartilage condition at the surgery were not risk factors. In contrast, the extent of meniscectomy affected the incidence rate. Conclusions: This study suggests a positive correlation between arthroscopic meniscectomy and postoperative bone marrow signal changes of the knee.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 238–245     

Knee joint biomechanics following arthroscopic partial meniscectomy

We investigated spatiotemporal data, joint kinematics, and joint kinetics during gait in a group of subjects who had recently undergone arthroscopic partial meniscectomy and compared the results to those of healthy controls. Gait analysis was performed on 105 pain‐free meniscectomy patients and 47 controls, walking at a self‐selected speed. The meniscectomy population was comparable to controls in spatiotemporal parameters and knee kinematics. However, they had reduced range of motion (ROM) and lower peak moments in the sagittal plane on the operated limb compared to the nonoperated limb. Compared to controls, the meniscectomy patients had significantly larger knee adduction moments over stance, even after accounting for their greater body weight. These differences likely increase articular loads on the medial compartment of the tibiofemoral joint and may contribute to the high risk of knee osteoarthritis following arthroscopic meniscal surgery. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1075–1080, 2008     

关节镜下病灶清理术治疗膝关节骨关节炎的疗效分析

目的 探讨关节镜下病灶清理术治疗膝关节骨关节炎疗效的影响因素.方法 回顾性分析2009年1月1日至2010年12月31日37例膝关节骨关节炎患者术前、术后1个月、术后6个月及术后1年的情况,膝关节的疼痛和功能采用VAS评分及Lequesne指数作出评定,通过Logistic回归分析对影响手术疗效的相关因素进行分析.结果 术后患者VAS评分、Lequesne指数均得到明显降低(P＜0.05).多因素分析结果显示:体重指数BMI(OR=7.15,95％CI:1.52～32.16)、关节面夹角(OR=7.71,95％ CI:1.85～38.19)影响术后疗效,其差异有统计学意义(P＜0.05).结论 关节镜下病灶清理术治疗膝关节骨关节炎疗效受到体重指数BMI及患者关节面夹角的影响.     

Problems with repeated arthroscopic surgery in the discoid meniscus

To identify the main causes of repeated arthroscopic surgery of the knee joint and to find out the points of therapeutic approaches, we evaluated 139 patients who underwent arthroscopic meniscectomy in our department and in affiliated hospitals between 1983 and 1987. Two or more arthroscopic surgeries were needed in 9 knees of 8 patients (6.5%). In 5 knees with no known injuries, the primary reason for repeated surgery was horizontal tears of remnant meniscus after partial resection of lateral discoid meniscus. The most appropriate initial treatment for lateral discoid menisci in cases without tear should be observation of the clinical course with minimal treatment using diagnostic arthroscopy.     

Revision arthroscopic partial meniscectomy of the knee. A retrospective review

The aim in this study was to find out if there were any revision operations in patients who underwent an arthroscopic partial meniscectomy and we attempted to identify the factor(s) that may be associated with the need for that revision. We reviewed 1,603 patients who underwent an arthroscopic partial meniscectomy, and 16 cases of revision were identified (rate 1%). Nine factors were analysed: age, sex, affected knee, affected meniscus, private or National Health Service (NHS) patient, symptoms prior to the most recent meniscectomy, type of tear, history of re-injury and the progression of Outerbridge changes to the articular surfaces. There was a significant risk for a revision meniscectomy in patients with horizontal/partial thickness tears compared to flap tears. No additional factor analysed was significantly associated with a revision procedure.     

A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up

Purpose: Our goal was to compare results of partial medial arthroscopic meniscectomy with results of partial lateral arthroscopic meniscectomy and to determine prognostic factors. Type of Study: Retrospective comparative study with statistical analysis. Methods: In this study, 362 medial and 109 lateral isolated arthroscopic meniscectomies are presented with a minimum follow-up time of 10 years. All knees were stable with no previous surgery or traumatic lesion. Results: In this study, 95% of the patients were very satisfied or satisfied with the results of the medial meniscectomy, and 95.5% with results of the lateral meniscectomy (P = .32). According to grades 1 and 2 of the Intenational Knee Documentation Committee (IKDC) form, 85.8% of the medial meniscectomy group were free of any symptoms, as were 79.7% of the lateral meniscectomy group (P = .11). Radiologic changes after medial and lateral meniscectomy were found in 21.5% and 37.5%, respectively (P = .11). The rates of radiologic changes in patients in whom the contralateral knee was radiologically normal were 22.3% and 39%, respectively (P = .016). The rate of repeat surgeries for osteoarthritis was less than 0.2%. Conclusions: Subjective and clinical results after medial or lateral meniscectomy are quite similar, but radiologic results are significantly worse after lateral meniscectomy. The most accurate way to determine the degeneration caused by the meniscectomy is to evaluate joint space narrowing in patients in whom the contralateral knee was radiologically normal. Otherwise, partial medial or lateral meniscectomy are well tolerated. A better prognosis can be predicted for a patient with an isolated medial meniscal tear with one or more of the following factors: age less than 35 years, a vertical tear, no cartilage damage, and an intact meniscal rim at the end of the meniscectomy. With an isolated lateral meniscal tear, a better prognosis can be predicted if the patient is young and has an intact meniscal rim at the end of the meniscectomy.     

MRI Evaluation of Isolated Arthroscopic Partial Meniscectomy Patients at a Minimum Five-Year Follow-up

Background The risk of radiographic knee degeneration after partial or total meniscectomy is well documented, but no prior study has employed cartilage-sensitive MRI technology to assess degenerative changes after meniscectomy. Hypothesis Arthroscopic partial meniscectomy results in early articular cartilage wear and subchondral bony degeneration, even in the absence of clinical symptoms, and these findings can be evaluated with cartilage-sensitive MRI. Study design Retrospective cohort. Methods Twenty-nine patients (ages: 15–40) who had undergone isolated arthroscopic partial medial or lateral meniscectomy with at least 5-year follow-up were evaluated. All patients had arthroscopically normal articular cartilage at the time of initial meniscectomy. Seventeen patients (18 knees) underwent partial medial meniscectomy (MM) and 12 patients underwent partial lateral meniscectomy (LM) with mean follow-up of 8.4 and 7.1 years, respectively. Follow-up evaluation included physical examination, outcome questionnaires, and cartilage-sensitive MRI examination with modified Outerbridge grading of articular surfaces. Results Outerbridge grades II–IV were noted in 64% of medial compartment joint surfaces in group MM knees versus 33% of lateral compartment joint surfaces in group LM knees. Abnormal cartilage surfaces (grades II–IV), subchondral sclerosis, and condylar squaring were all significantly more frequent after medial meniscectomy (p < 0.05). Groups MM and LM had no significant differences among outcome scores, which remained excellent in both groups. A significant negative correlation was found between the severity of cartilage wear and functional scoring in the MM group, suggesting that functional disability lags behind early MRI evidence of degeneration. Conclusions Despite optimal preoperative prognostic factors and excellent functional outcomes, MRI evidence of early articular cartilage degeneration was present in both partial medial and lateral meniscectomy patients at a minimum 5-year follow-up. Results support the use of cartilage-sensitive MRI as a noninvasive screening technique to evaluate cartilage changes after arthroscopic partial meniscectomy and may help to counsel the high-risk patient in regard to postoperative activity.     

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。     

Arthroscopic meniscectomy for discoid lateral meniscus in children

We reviewed the cases of forty-six children who were less than fifteen years old and in whom total, subtotal, or partial arthroscopic meniscectomy was performed for symptomatic discoid lateral meniscus in fifty-three knees. The average length of follow-up was 31.2 months. A meniscal tear was evident in each knee. The extent of the meniscectomy depended on the site and shape of the tear, as did the symptoms and signs. We tried to establish the width of partial meniscectomy of a discoid meniscus that would prevent new tears.