关节镜下膝外侧盘状半月板成形术

关节镜下膝外侧盘状半月板成形术温宏孔建中近年来对半月板生物力学的进一步研究肯定了半月板在膝关节功能中的重要性，提出应尽量保留半月板组织。作者做了１２例关节镜下盘状半月板成形术，取得了满意的疗效。报告如下。１临床资料１９９１～１９９５年共做了２８例膝关...     

膝外侧动脉皮瓣的应用解剖

在52侧成人下肢标本上,对膝外侧动脉供血区的皮肤作了应用解剖学研究。这一皮瓣主要是由膝上外侧动脉发出的直接皮动脉供血。皮瓣的营养血管是恒定的、可靠的。皮动脉以很小的角度在股骨外侧髁稍上方由膝上外侧动脉发出,从股外侧肌、股二头肌肌间隙穿出深筋膜,并和旋股外侧动脉、腘动脉直接皮支、膝下外侧动脉有丰富的吻合。测量了皮瓣血管蒂的管径、长度、皮动脉的分支范围,并讨论了临床应用的有关问题。     

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。     

关节镜技术在膝外侧盘状半月板损伤中的应用

目的探讨关节镜在盘状半月板损伤中的治疗作用。方法对23例膝外侧盘状半月板损伤患者施行关节镜下盘状半月板部分或大部分切除成形术。结果术后4例并发关节血肿。23例随访5～22个月,平均9．7个月。按Lysholm等膝关节功能评分标准,优19例,良3例,中1例。结论关节镜微创技术诊疗盘状半月板损伤具有确诊率高．创伤小等优点,术后膝关节症状缓解明显,病变关节功能得到明显恢复。     

旋股外侧动脉降支与膝外上动脉双轴点皮瓣的临床应用

目的 报道旋股外侧动脉降支与膝外上动脉双轴点皮瓣修复膝关节周围软组织缺损的临床效果. 方法 以旋股外侧动脉降支与膝外上动脉为血管轴,髌骨外上缘为轴点,以旋股外侧动脉第一肌皮穿支为第二轴点设计皮瓣,修复膝部软组织缺损3例. 结果 3例皮瓣全部成活,质地外形满意. 结论 利用旋股外侧动脉降支-膝外上动脉双轴点皮瓣很大程度延长了血管蒂的长度,从而有效地扩大了皮瓣的适用范围.     

膝内侧盘状半月板1例报告

盘状半月板临床上并不常见,其中多为外侧盘状半月板,内侧盘状半月板罕见.作者在临床中发现内侧盘状半月板1例,行关节镜下盘状半月板成形术,恢复良好,报告如下.     

关节镜外侧半月板下入路技术用于外侧半月板前角层裂下层的切除

目的探讨关节镜外侧半月板下入路切除外侧半月板前角下层的效果。方法 2008年1月～2010年12月,对10例外侧半月板前角层裂采用关节镜外侧半月板下入路切除外侧半月板前角层裂中不稳定的下层。采用3个入路：膝前外侧入路,前内侧入路及外侧半月板下入路。自前内侧入路置入关节镜观察;经前外侧入路使用探沟翻转层裂上层,并尽可能显露下层;经外侧半月板下入路使用直头Punch（篮钳）切除半月板前角层裂的下层。结果无术后并发症。6例术后MRI检查均显示半月板前角下层完全切除。10例随访12～45个月,平均18.9月：9例膝关节完全不痛,1例偶尔运动后疼痛;10例膝关节活动范围均恢复至正常;膝关节Lysholm评分由术前（68.7±12.9）分提高到术后随访时的（94.4±5.7）分（配对t检验,t=7.79,P=0.00）。结论关节镜外侧半月板下入路可安全、有效切除外侧半月板前角层裂中不稳定的下层。     

关节镜下半月板成形术对老年半月板损伤患者膝功能恢复的影响

目的探讨关节镜下半月板成形术对老年半月板损伤患者膝功能恢复的影响。方法选取70例老年膝关节半月板损伤患者,根据手术方法分为2组。对照组36例,给予半月板切除术;观察组34例,给予半月板成形术。对比分析2组治疗效果及lysholm膝关节功能评分。结果对照组治疗总有效率及lysholm膝关节功能评分均明显低于观察组,差异有统计学意义(P0.05)。结论对老年半月板损伤患者实施关节镜下半月板成形术治疗,可明显促进膝关节功能恢复,提高患者生活质量,效果较好。     

经胫骨隧道止点重建治疗外侧半月板后角撕裂的临床疗效观察

目的 探讨关节镜辅助下经胫骨隧道止点重建治疗外侧半月板后角撕裂的临床疗效.方法 回顾性分析2016年6月至2018年6月深圳市龙岗区骨科医院采用关节镜辅助下经胫骨隧道止点重建治疗膝关节外侧半月板后角撕裂的19例病人,其中男12例,女7例;年龄为16～45岁,平均32.3岁.11例伴有前交叉韧带断裂.收集并比较19例病人...     

Suturing Complete Radial Tears of the Lateral Meniscus

Lateral meniscus (LM) with complete radial tear (CRT) is common in patients with acute anterior cruciate ligament (ACL) injury. We have been approximating unstable LM CRT in an all-inside suture fashion. We report 3 cases of complete healing of such a torn meniscus on second-look arthroscopy. We recommend approximation of the displaced CRTs of the LM whenever possible because we expect improved healing with this approach. Surgically, the arthroscope is placed into the anteromedial portal and the suture hook into the anterolateral portal with the knee in figure-of-4 position. A suture hook loaded with Ethilon No. 1 (Ethicon, Somerville, NJ) is introduced into the anterolateral portal, and vertical penetration to a single end of the torn LM is achieved. The Ethilon is pushed out until the far-end limb is almost exhausted. The suture hook is removed from the portal, with caution taken not to pull out the penetrated limb from the meniscus. A universal cannula is introduced, and the leading limb is grasped and pulled out. The Ethilon is used as a shuttle relay and is changed to polydioxanone (PDS) II. The suture hook is reintroduced, and the other torn end is penetrated in the same fashion. With complete suture to both meniscal sides, 2 suture limb ends are pulled out, and arthroscopic tying (SMC knot) is performed.     

All-Inside Suture Technique Using Anterior Portals in Posterior Horn Tears of Lateral Meniscus

Methods for the repair of meniscal tears include inside-out, outside-in, and all-inside techniques. In this article an all-inside technique is proposed for the posterior horn of the lateral meniscus that takes advantage of the capacious posterolateral recess when the knee is flexed. A device consisting of a large needle with a buttonhole in the tip (previously used for inside-out suture of the medial meniscus) is used. This technique uses only anterior portals (anteromedial and anterolateral portals and an accessory lateral or transpatellar tendon portal). The arthroscope is inserted through the accessory portal. Once the tear has been located and its edges refreshed, the suture device is placed anterolaterally. The tip of the needle is loaded with suture and passed through both sides of the tear and into the posterolateral recess of the knee (without exiting the capsule). The suture tail is recovered with the use of a suture retriever through the anteromedial portal. Next, the suture retriever is inserted through the anterolateral portal to once again retrieve and shuttle the tail before completion of an arthroscopic knot. In addition to the ease of the technique, use of this simple, reusable device adds the benefit of low cost when compared with other techniques.     

膝降动脉岛状皮瓣修复膝周组织缺损的临床研究

目的探讨膝降动脉岛状皮瓣修复膝周组织缺损的临床效果。方法回顾性分析2009年6月~2013年6月我科收治的12例(共13侧)膝周组织缺损患者的临床资料,其中右侧8例,左侧3例,双侧1例,受伤至手术时间为1~21 d,平均(5.4±3.8)d。本组患者的膝周缺损面积为(3 cm×4 cm)~(6 cm×8 cm)。均采用膝降动脉岛状皮瓣修复膝周缺损,供区直接拉拢缝合2例,行游离皮片移植10例。观察皮瓣成活情况及膝关节活动情况。结果本组所有皮瓣均成活,其中11例患者皮瓣转移后均一期愈合,1例患者术后5 d出现皮瓣远端坏死,经换药后愈合。供区游离植皮的10例患者皮片均成活良好,直接拉拢缝合的2例创口愈合形成不明显的线性瘢痕。本组12例均获随访,随访时间6个月~3年,平均(2.4±0.8)年。所有患者膝关节均活动良好,下蹲及行走均恢复良好。结论膝降动脉岛状皮瓣可有效保全膝关节活动,是修复膝周软组织缺损的良好选择。     

Chinese Experts Consensus and Practice Guideline on Discoid Lateral Meniscus

Discoid lateral meniscus (DLM) is the most common congenital variant of the lateral meniscus, which is prone to degeneration and lesions, and often leads to knee osteoarthritis. At present, there is no consensus on the clinical practice of DLM, and this expert consensus and practice guidelines on DLM was developed and approved by Chinese Society of Sports Medicine according to the Delphi method. Among 32 statements drafted, 14 statements were excluded for redundant information, and 18 statements achieved consensus. This expert consensus focused on the definition, epidemiology, etiology, classification, clinical manifestations, diagnosis, treatment, prognosis, and rehabilitation of DLM. Restoring the normal shape, retaining appropriate width and thickness, and ensuring the stability of the remnant meniscus is critical to sustaining the physiological function of the meniscus and preserving the knee. The partial meniscectomy with or without repair should be the first-line treatment when possible, given that the clinical and radiological long-term outcomes of total or subtotal meniscectomy are worse.     

关节镜下治疗盘状半月板疗效及其影响因素分析

目的总结我院21例关节镜下治疗外侧盘状半月板的临床效果,分析影响盘状半月板疗效的因素。方法选择2008年1月至2011年1月关节镜下行外侧盘状半月板手术的患者21例,其中男性8例,女性13例;年龄18～56岁,平均40.9岁。术后21例患者均获得随访,随访时间9～35个月,平均22.3个月。结果所有随访的患者手术后临床症状基本消失,术后6个月按Ikeuchi评分进行评估,优17例,良3例,可1例,优良率95.23%。手术前后Lysholm评分、Tegner运动能力评分具有明显的差异性(P=0.000)。年龄与半月板的分型在一定程度上影响盘状半月板的临床疗效,而性别、外伤史、撕裂方式、手术方式没有明显的影响。结论关节镜下治疗外侧盘状半月板的临床疗效是值得肯定的,且关节镜手术具有创伤小、诊治结合、术后恢复快的特点,是治疗盘状半月板损伤的有效方式。     

Arthroscopic Avulsion Repair of a Pediatric ACL with an Anomalous Primary Insertion into the Lateral Meniscus

Background  

Injury to the anterior cruciate ligament (ACL) in the pediatric population is becoming more common, with the majority of ruptures occurring at the tibial insertion site. However, to our knowledge, there are no reports of avulsion in which the primary ACL insertion site is the anterior lateral meniscal root.