肘关节剥脱性骨软骨炎关节镜治疗中期疗效

[目的]评价关节镜技术在肘关节剥脱性软骨炎诊断、治疗中的作用以及疗效。[方法]2011年5月~2014年7月,对17例患者施行肘关节镜检查、滑膜清理、游离体取出以及微骨折术,男11例,女6例;年龄15~35岁,左侧5例,右侧12例。17例均有肘关节疼痛,10例有肘关节卡压或绞锁等机械症状。患者取侧卧位全身麻醉下,经中外侧(软点)、近端前外侧、近端前内侧、后正中、后外侧等入路,行肘关节探查、清理、游离体取出以及微骨折术。分别测量术前术后肘关节伸直角度、屈曲角度、肘关节活动度,应用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评价疗效。[结果]术后患者伤口均I期愈合,无血管损伤并发症,17例获得10~48个月,平均28.5个月随访。术后15例(88.2%)肘疼痛消失或仅有轻微疼痛,2例(11.8%)肘仍有中等程度疼痛。10例有机械交锁症状者均消失。肘关节伸直角度、屈曲角度、肘关节活动度以及MEPS值均较术前明显改善(P0.05),术后MEPS结果优11例,良3例,中2例,优良率:88.2%。术后并发症:1例尺神经暂时性麻痹。[结论]肘关节镜治疗肘关节剥脱性软骨炎疗效确切,可以明显缓解肘关节疼痛,改善关节活动范围,损伤小、恢复快。     

踝关节镜下治疗距骨剥脱性骨软骨炎

目的探讨踝关节镜技术在距骨剥脱性骨软骨炎治疗中的应用及效果。方法对17例距骨剥脱性骨软骨炎患者施行踝关节镜手术,在关节镜下对损伤关节面清创、搔刮及钻孔。结果随访14．54个月。踝关节Kofoed评分由术前平均56．5分提高至89．4分,17例中优6例,良8例,可2例,差1例,优良率为82．4％。结论踝关节镜下手术治疗距骨剥脱性骨软骨炎,疗效确切,具有创伤小、并发症少、恢复快等优点。     

关节镜下诊治青少年肘关节剥脱性骨软骨炎

目的探讨肘关节镜在青少年肘关节剥脱性骨软骨炎诊断和治疗中的作用。方法2003年5月~2006年2月,应用关节镜诊治肘关节剥脱性骨软骨炎患者11例。男6例,女5例;年龄13~19岁。左侧4例,右侧7例。其中7例有明显外伤史。于伤后7个月~12年手术。术前VAS评分80±10分,屈伸活动度80±10°,旋转活动度100±5°。臂丛神经阻滞麻醉下,经软点、内上、外上等入路,行肘关节探查、游离体取出及清理术。结果术后7~12d,患者均恢复日常生活及工作,无神经、血管损伤等并发症。11例患者均获随访6~18个月,平均12.5个月。参照改良HSS肘关节评分系统进行疗效评定,优7例,良4例。术后末次随访VAS评分32±15分,屈伸活动度110±10°,旋转活动度120±5°,与术前比较差异均有统计学意义(P<0.05)。结论肘关节镜具有损伤小、恢复快、功能改善显著、并发症少等优点,是诊断和治疗青少年肘关节剥脱性骨软骨炎的一种有效方法。     

肱骨小头剥脱性骨软骨炎的关节镜治疗

目的 了解肱骨小头剥脱性骨软骨炎的关节镜下表现，探讨其关节镜下治疗方法及手术疗效。方法 回顾性研究1998年7月～2005年6月期间通过关节镜治疗的33例肱骨小头剥脱性骨软骨炎患者，手术包括取出关节内游离体，切除病灶周围松动的骨软骨，清理关节内其它部位损伤的软骨。结果 平均手术时间为53min，术中发现18例（54．5％）患者肘关节前方存在游离体，11例（33．3％）患者鹰嘴窝中存在游离体，10例（30．3％）患者仅肱桡关节间隙内存在游离体。12例患者伴有尺骨鹰嘴和肱骨滑车软骨的病变。术后仅7例患者需要口服索米痛止痛。所有患者获得平均3．2年（6～70个月）随访，肘关节的HSS评分由术前平均（78．00±16．35）分提高至术后平均（94．00±10．67）分，差异有统计学意义（P〈0．01）。30例患者均恢复术前训练水平，2例患者残留支撑时关节疼痛，1例患者有桡神经深支的损伤。结论 肘关节镜治疗肱骨小头剥脱性骨软骨炎切口小、创伤小、并发症少、效果满意，对病灶的了解和处理更加全面、彻底，是一种安全、满意的治疗方法。     

关节镜辅助下同种异体骨软骨移植修复膝关节剥脱性骨软骨炎

目的 评价关节镜辅助下采用同种异体骨软骨移植修复膝关节剥脱性骨软骨炎(osteochondritis dis-secans,OCD)伴大面积骨软骨缺损的可行性和有效性.方法 2004年1月-2007年5月,收治13例膝关节股骨髁OCD伴大面积骨软骨缺损患者.男7例,女6例;年龄18～59岁.左膝8例,右膝5例;病程7 d～20年,中位病程为42个月.4例有明确膝关节扭伤史.受累部位:股骨内侧髁外侧份5例,股骨内侧髁滑车面2例,股骨外侧髁6例.主动关节活动度为(95.0±13.5)°.Lysholm膝关节功能评分为(62.23±7.79)分.软骨损伤根据国际软骨修复协会分型和关节镜下的Guh1分型,均为Ⅳ型.关节镜下见骨软骨缺损面积为3～7 cm2,平均4.32 cm2;缺损深度0.8～2.0 cm,平均1.55cm.采用同种异体骨软骨块修复缺损,并联合可吸收钉固定骨软骨块.术后指导功能锻炼.结果 术后伤口均Ⅰ期愈合.13例均获随访,随访时间1年2个月～4年,平均2.2年.术后3个月2例持续活动1 h以上后膝关节疼痛,指导其功能锻炼后缓解.术后6个月2例关节摩擦感明显,关节稳定性尚好,予药物保守治疗.末次随访时主动关节活动度为(137.0±9.8)°,与术前比较差异有统计学意义(P<0.05).X线片检查示术后4～6个月移植骨软骨与受区松质骨融合,关节面平整,关节间隙正常.末次随访EMRI检查示骨软骨愈合,关节面完整;骨软骨移植物无缺损、退行性变.术后1年Lysholm膝关节功能评分为(92.08±7.64)分,与术前比较差异有统计学意义(P<0.05).结论 对于膝关节股骨髁OCD伴大面积骨软骨缺损,在关节镜辅助下采用同种异体骨软骨移植修复缺损能重建关节面的完整性和恢复关节稳定性,可取得良好的治疗效果.     

创伤致剥脱性骨软骨炎13例

创伤致剥脱性骨软骨炎１３例奚晶，姚建祥我院自１９８８年至１９９４年４月收治创伤所致剥脱性骨软骨炎１３例，分期治疗，效果满意。现报告如下：１临床资料本组１３例，男９例，女４例。年龄１８—４２岁，平均２６．３岁。创伤分类：训练伤６例、交通伤５例、砸伤２例...     

幼年型剥脱性骨软骨炎研究进展

幼年型剥脱性骨软骨炎（JOCD）好发于男性,创伤、血供障碍及关节周围结构异常等均可能是重要致病因素。发病早期缺乏典型临床表现,易被漏诊。MRI是首选检查方法,可定位、定性地诊断并有助于分型。对于稳定型JOCD患者,保守治疗是最佳选择;对不稳定型或经保守治疗效果较差者,可采用剥离软骨片固定、软骨下骨钻孔、自体骨软骨移植及自体软骨细胞移植等手术治疗。JOCD不同于成年型剥脱性骨软骨炎,治疗方法差别明显。损伤时间和损伤部位、程度、范围等均对预后产生重要影响,早期诊断是获得良好预后的重要条件。     

剥脱性骨软骨炎研究现状

剥脱性骨软骨炎（ＯＣＤ）指由各种原因导致的区域性关节软骨及其深层的骨质缺血坏死、并与周围健康骨质分离为特征的一类关节疾病，可发生于全身任何关节，但以膝关节发病最为常见〔１〕。本文即以膝关节为主叙述。由于此病比较少见（国外统计为１５／１０万～２０／１０万），所以很容易与骨软骨骨折（ＯＣＦ）混淆。它们的主要区别在于ＯＣＦ多由外伤引起，致骨折块分离和关节腔出血，分离线通过正常骨；而ＯＣＤ骨块剥离过程逐渐发生，分离线通过缺血骨。ＯＣＦ早期Ｘ线平片便可发现，但发现较晚时则容易误诊为ＯＣＤ。ＯＣＤ被广泛认为…     

剥脱性骨软骨炎

剥脱性骨软骨炎（osteochondritis dessecans,OCD）是指由各种原因导致的局部性关节软骨及其软骨下骨缺血性坏死、并与周围正常骨质分离为特征的一类关节疾病,由Konig命名为剥脱性骨软骨炎,好发于青少年和成年男性,男性是女性的2倍。     

儿童和青少年股骨头剥脱性骨软骨炎7例临床治疗观察

[目的]探讨儿童和青少年股骨头剥脱性骨软骨炎临床和诊断要点。[方法]对7例患儿的临床表现、影像学特点、手术进行回顾性研究。[结果]7例经过短期的保守治疗后有6例手术切除软骨碎片和游离的变性软骨，刮除砂粒状骨质，修整缺损的基底部和边缘，平整股骨头表面。1例保守治疗3个月后失随访。6例手术病例分别随访1～4年，平均随访2年。术后3个月疼痛缓解，1年后跛行逐渐改善，无髋关节疼痛和关节交锁。X线检查股骨头缺损改善不明显，关节间歇没有变窄。[结论]儿童青少年剥脱性骨软骨炎应早期诊断，积极治疗，手术可最大限度地保持病人的正常活动。     

Arthroscopic Treatment of Osteochondritis Dissecans of the Talus

We report on a retrospective study of 33 patients who underwent arthroscopic treatment for osteochondritis dissecans of the talus. Twenty-eight of the patients (85%) had a history of mild to moderate trauma. Arthroscopic treatment consisted of removal of the osteocartilaginous fragments, debridement of disrupted cartilage, and abrasion of the base to bleeding subchondral bone. The average duration of follow-up was 7.4 years with a range of 2 to 18.3 years. Follow-up showed statistically significant improvement in terms of pain, swelling, stiffness, limp, and activity level.     

Arthroscopic Treatment After Previous Failed Open Surgery for Osteochondritis Dissecans of the Talus

SUMMARY: We report on 8 patients with persistent ankle pain after open surgery for osteochondritis dissecans of the talus. At an average of 35 months after initial surgery, arthroscopic treatment was performed in these patients. The patients had residual loose chondral and osteochondral debris at the site of the original lesion. The remaining loose cartilage was removed and abrasion of the defect to a bleeding base was performed. Follow-up of these patients at an average of 38 months showed statistically significant improvement in terms of pain, swelling stiffness, limp, and activity level.     

A New Arthroscopic-Assisted Drilling Method Through the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

We developed a new arthroscopic-assisted drilling method through the radius in a distal-to-proximal direction for osteochondritis dissecans (OCD) of the elbow. Only 1 drill hole is created in the radius by use of a single 1.8-mm K-wire inserted from the shaft of the radius approximately 3 cm distal to the humeroradial joint into the joint, which allows drilling of the entire OCD lesion. The forearm is supinated so that the tip of the K-wire is at the lateral side of the lesion in the humeral capitellum, and drilling is performed at 30° elbow flexion. The flexion angle is changed from 30° to 60° to 90° to 120° while maintaining supination, to drill in 4 sites (1 site for each angle of flexion) of the lateral side of the OCD lesion. Next, we move the forearm from supination to pronation so that the tip of the K-wire is placed in the medial side of the lesion in the humeral capitellum, and as with the lateral side, drilling is performed in 4 sites. With this technique, the entire OCD lesion can be vertically drilled under arthroscopic guidance. This method is minimally invasive, and an early return to sports could be possible.     

Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results,Magnetic Resonance Imaging,and Second-Look Arthroscopic Findings

Background

This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain.

Methods

The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up.

Results

Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases.

Conclusions

For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.