关节镜术诊断和治疗膝骨性关节炎前交叉韧带撞击症

目的 报道膝骨性关节炎前交叉韧带撞击症15例,探讨关节镜对该病的诊断分型和治疗方法.方法 对15例膝骨性关节炎前交叉韧带撞击症患者的症状、体征、放射检查、关节镜下表现和治疗方法进行总结分析.结果 15例全部随访.平均随访时间16.5个月.术后患者膝关节不适症状消失,屈伸功能障碍明显改善.结论 所有患者均合并骨性关节炎,该病是由于股骨髁间窝继发性狭窄、胫骨髁间嵴增生增高或前交叉韧带胫骨起点骨赘增生造成膝关节伸直位撞击而出现相应临床症状.关节镜下可将该病分为3型:股骨髁间窝型、胫骨髁间嵴型和混合型,关节镜下股骨髁间窝扩大成形术、胫骨髁间嵴部分切除术或前交叉韧带胫骨起点骨赘切除术是治疗该病的有效方法.     

关节镜下治疗退行性膝关节炎髁间撞击征43例

目的:探讨退行性膝关节炎髁间撞击征的诊断及治疗方法。方法:43例退行性膝关节炎髁间撞击征患者,采用关节镜清理术加镜下髁间窝扩大成形术进行治疗。结果:随访6~36个月(平均13个月),疗效评定:优23例、良14例、可4例、差2例,优良率86%。结论:膝关节镜检查发现前交叉韧带和股骨髁间窝发生撞击现象是诊断的重要标准,关节镜清理术加镜下髁间窝扩大成形术治疗退行性膝关节炎髁间撞击征不仅可以有效地消除骨髁间窝前交叉韧带撞击现象,也是一种损伤小、恢复快的有效方法。     

关节镜下退行性膝骨关节炎合并前交叉韧带撞击症的诊治

目的探讨关节镜下退行性膝骨关节炎(KOA)合并前交叉韧带撞击症的诊治方法。方法选取有骨性关节炎前交叉韧带撞击症的患者36例,男20例(20膝),女16例(16膝),13例患者髁间窝骨赘,9例患者胫骨髁间嵴形成骨赘,9例患者髁间窝滑膜增生肥厚,5例患者膝关节含游离体。对其症状、体征、关节镜下的表现进行总结分析,行股骨髁间窝扩大成形及关节清理术。结果 36例病例随访6~12个月,患者术后病情明显好转,膝关节功能改善。患者术前Lysholm评分平均57分(40~76分),术后1个月平均69分(67~72分),平均增加12分;术后3个月平均74分(65~77分),平均增加17分;术后6个月平均86分(71~96分),平均增加29分,与术前比较差异均有统计学意义(P0.05)。结论 KOA患者不仅要在关节镜下清除关节内碎裂的退变软骨和增生的骨赘,去除游离体,修整半月板,同时也要注意前交叉韧带的撞击情况,去除撞击因素,改善患者预后。     

关节镜治疗膝关节髁间窝撞击症33例

目的通过对髁间窝撞击造成的膝关节屈曲畸形在关节镜下的处理,总结对髁间窝撞击的治疗效果。方法对33例,35膝屈曲畸形的膝关节进行去除骨赘,扩大髁间窝的治疗,改善膝关节伸直角度。结果随访时间13～18个月,平均16.2个月,其中优9例,良14例,可6例,差4例,优良率达69.6%。最大改善角度30°。结论在关节镜下清理股胫关节骨赘,可以有效地改善屈曲畸形,创伤小,恢复快,痛苦小,费用低,是一种比较好的治疗方式。     

关节镜下膝关节胫骨髁间前区骨折闭合复位空心螺钉内固定治疗疗效观察

目的:探讨膝关节镜下胫骨髁间前区骨折复位空心螺钉内固定治疗的新途径、新术式。方法:自2003年5月~2005年10月我科对收治的12例胫骨髁间前区骨折患者,按照meyers-mekeever胫骨髁间区骨折的分型[1],Ⅰ型3例,Ⅱ型7例,Ⅲ型2例。采用关节镜下经膝关节镜入路撬拔复位骨折,克氏针作导针,空心螺钉内固定手术。结果:术后12例患者均随访4~32个月,平均18个月,膝关节活动度正常11例,1例固定螺钉退出,撞击髁间窝,膝关节伸直受限,关节镜下手术取除螺钉,功能恢复满意。复查X线片示,骨折全部愈合,膝关节稳定。结论:关节镜下胫骨髁间前区骨折复位空心螺钉内固定治疗,创伤小,复位固定可靠,既达到内固定的效果,又避免了切开复位对组织的创伤和对关节腔的侵扰,并可早期功能锻炼,疗效满意,是一种简便易行的好治疗方法。     

关节镜下治疗儿童胫骨髁间嵴骨折

目的 探索膝关节镜下治疗儿童胫骨髁间嵴撕脱骨折的治疗和手术体会。方法 总结关节镜下治疗儿童胫骨髁间嵴撕脱骨折23例。结果 术后X线片显示所有骨折复住满意，随访18例，随访时间6月-3年6月，平均1年10个月，所有患者膝关节活动度正常，其中1例合并半月板损伤患者虽行半月板部分切除，膝关节屈伸时偶有弹响，但无交锁，所有患者未见明显创伤性关节炎。结论 关节镜下治疗儿童胫骨髁间嵴撕脱骨折具有微创特点，操作简单，固定可靠，创伤小，是治疗儿童胫骨髁间嵴撕脱骨折的一种新方法。     

关节镜下带线铆钉原位重建前交叉韧带胫骨髁间嵴粉碎性撕脱骨折

目的探讨关节镜下带线铆钉原位重建前交叉韧带(ACL)胫骨髁间嵴粉碎性撕脱骨折(Meyers Mckeever分型系统分为Ⅳ型)的临床疗效。方法对该科2009年10月-2015年4月收治15例ACL胫骨髁间嵴粉碎性撕脱骨折运用关节镜复位,带线铆钉原位重建,并通过胫骨结节骨隧道固定,手术后10例患者得到了随访,并进行回顾性分析。手术前常规行三维CT及MRI检查。15例患者均在受伤后21 d内进行了手术治疗,Meyers和Mckeever分型均为Ⅳ型,年龄为20~58岁,男10例,女5例,9例为慢速车祸外伤,4例为运动损伤,摔伤2例。手术前抽屉试验及Lachman征阳性,Lyscholm评分为(45.5±4.5)分,国际膝关节评分委员会(IKDC)2000评分为(52.6±3.2)分。结果对手术前、手术后第6和12个月行常规X线影像学检查,手术后6个月全部骨折愈合。前抽屉试验及Lachman试验阴性,IKDC 2000评分为(91.2±2.2)分,Lyscholm评分为(96.5±1.2)分,通过上述评分系统对手术前和手术后6个月的得分进行统计学分析,手术前与手术后6个月有着明显差别,两者差异具有统计学意义。结论关节镜下运用带线铆钉治疗ACL胫骨粉碎性撕脱骨折,具有复位精准,创伤小,可以最大限度避免膝关节副损伤,远期出现膝关节僵硬的几率变小,关节镜治疗ACL胫骨髁间嵴粉碎性撕脱骨折是一种可靠有效的治疗方式。     

关节镜下空心钉复位与改良10#爱惜康丝线内固定治疗胫骨髁间嵴骨折的疗效比较

目的比较关节镜下空心钉复位与改良10#爱惜康丝线治疗胫骨髁间嵴骨折疗效。方法选取胫骨髁间嵴撕脱骨折21例,其中空心钉内固定组11例,改良10#爱惜康丝线固定组10例。观察2组手术时间、骨折愈合时间、膝关节活动度、并发症、Lysholm膝关节评分变化情况。结果改良10#爱惜康丝线固定组在手术时间上显著长于关节镜空心钉内固定组(P0.05),而2组在术中出血量、住院时间、骨折愈合时间上、膝关节屈伸活动度、Lysholm膝关节评分、并发症等方面比较无显著差异(P0.05)。结论关节镜下复位空心钉内固定和改良10#爱惜康丝线均是治疗胫骨髁间棘骨折良好方式。     

膝关节镜下清理修复术治疗大骨节病的研究

目的探讨膝关节镜下关节清理修复术治疗大骨节病膝关节炎的方法及疗效。方法31例大骨节病患者,按郭巨灵的临床分期:Ⅱ期2例,Ⅲ期20例,Ⅳ期9例。关节镜下摘除游离体;修整破损的半月板、剥脱的软骨;切削增生的滑膜;打磨股骨髁间窝、内外髁及胫骨平台的骨赘;在软骨破损骨裸露处钻孔。结果29例随访2年,主观指标:患者自我评价,显效28例,有效1例,总有效率100%;客观指标:疼痛指数;关节活动度;行走范围;30°、60°单腿站立。除关节活动度外其余客观指标均有明显改善。结论膝关节镜下关节清理修复术对治疗大骨节病膝关节炎具有良好的疗效。     

X线隧道位结合前后正侧位、髌骨轴位检查在膝关节骨性关节炎诊断中应用分析

目的:观察X线隧道位结合前后正侧位、髌骨轴位检查在膝关节骨性关节炎诊断中的应用价值。方法:选取本院2015年1月至2017年2月收治的膝关节骨性关节炎患者150例,150例患者分别实施膝关节X线常规前后正侧位摄片、髌骨轴位摄片及隧道位摄片检查,对比分析不同摄片方式髁间窝骨赘、股骨内外髁骨质增生、胫骨棘骨赘、髁间窝游离体、关节腔游离体、关节面下囊变性、髌骨上缘骨质增生等影像学特征差异。结果:X线隧道位对髁间窝骨赘、股骨内外髁骨质增生、胫骨棘骨赘、髁间窝游离体等数量检出情况较常规X线前后正侧位及髌骨轴位更具优势,差异有统计学意义(P0.05);而在关节腔游离体、关节面下囊变性、髌骨上缘骨质增生等方面常规X线前后正侧位与髌骨轴位更具优势,差异有统计学意义(P0.05);而两种检查方式在膝关节间隙狭窄方面优势相当,差异无统计学意义(P0.05)。结论:在常规前后正侧位、髌骨轴位X线摄片基础上结合X线隧道位检查能够促进膝关节骨性关节炎诊断准确率提升,结合诊断较单一诊断更具临床优势及价值。     

Agénésie du ligament croisé antérieur et du ligament croisé postérieur du genou

This case report is an agenesia of the anterior and posterior cruciate ligament of the knee on a young man 35 year old. This malformation is rare and exceptional. The clinic is principally a knee laxity. On the plains radiographics, the diagnostic can be made because there is a hypoplasia or an agenesia of the tibial eminence and a malformation of the femoral intercondylar notch. MRI confirms the diagnostic.     

VKB-Verletzungsmuster und Augmentation von Partialrupturen

The anterior cruciate ligament (ACL) consists of the anteromedial (AM) and posterolateral (PL) bundles. In the clinical scenario a complete rupture of the ACL from the femoral footprint is most common. Partial ruptures are less frequently seen and involve intact tibial ACL fibres that attach to the posterior cruciate ligament (PCL) or intact tibial ACL fibres that attach high (AM) or low (PL) to the lateral wall of the notch. Conventional imaging techniques mostly miss the distinction between two bundles. The same is true for the conventional arthroscopist who is used to a standard diagnostic arthroscopy, which does not routinely include separation of the AM bundle from the PL bundle through the septum. An isolated rupture of the AM bundle (greatest tension in knee flexion) mainly influences the outcome of the anterior drawer test, whereas an isolated rupture of the PL bundle (greatest tension near knee extension) influences the Lachman test. The pivot shift test is utilized to diagnose anterolateral rotational instability (ALRI) and in some cases to diagnose PL ruptures. The pivot shift can, however, be negative in cases of isolated AM ruptures. Partial ruptures of the ACL should be treated with partial ACL reconstructions (augmentation). Techniques for reconstruction of the PL bundle and AM bundle are described in this article.     

Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography.

The accuracy of sonography in the diagnosis of acute rupture of the anterior cruciate ligament (ACL) was tested. Sixty-two patients with a recent traumatic haemarthrosis were examined. A haematoma at the origin of the ACL in the femoral intercondylar notch was interpreted as evidence of ligament injury. The standard of reference was arthroscopy or clinical follow-up. The sonographic findings were confirmed in 59 of 62 cases. The sensitivity was 88%, the specificity 98%, and the positive and negative predictive values 93 and 96%.     

膝前痛的关节镜下病因分析及诊断

目的 采用膝关节镜检术结合临床资料探讨引起膝前痛的关节内致病因素.方法 对该院自2000～2004年就诊的怀疑关节内因素导致的膝前痛病人120例,全部进行膝关节镜探查手术.结果 结合术中镜下及术后病理结果证实髌骨软骨软化症42例、髌股关节炎22例、髌股排列紊乱症21例、滑膜皱襞综合征15例;关节慢性非感染性炎症性疾病10例、髌前脂肪垫综合征7例、股骨髁间凹狭窄症3例.结论 利用膝关节镜技术并结合临床资料、影像学检查可对膝前痛的关节内因素进行病因分析及明确诊断,具有微创、高效、有限治疗等特点,是一种值得推荐的好方法.     

Modeling of ACL impingement against the intercondylar notch

Objective. To develop a 3-D mathematical model that accurately evaluates anterior cruciate ligament impingement against the intercondylar notch.

Design. The model simulated physical interactions between the anterior cruciate ligament and the intercondylar notch in tibiofemoral movement.

Background. Anterior cruciate ligament impingement has been evaluated through planar radiographic images, which may not characterize the complex 3-D notch shape associated with impingement.

Methods. After examining potential anterior cruciate ligament impingement in five cadaver knee specimens, the model was implemented using data from an individual cadaveric knee with representative impingement. The knee was loaded passively in various patterns to induce impingement, and the impingement force and six degrees-of-freedom tibiofemoral kinematics were measured. The femur, tibia, and anterior cruciate ligament were digitized. Spatial data points representing the notch surfaces were surface-fitted using bicubic splines. The model detected for impingement during the tibiofemoral movement and used a “crawling algorithm” to determine the deformed geometry of the impinging ligament.

Results. The model detected the impingement accurately and the ligament strain determined by the model was highly correlated with the recorded impingement force when impingement occurred during the tibiofemoral movement. Distance between the anterior cruciate ligament and the notch wall was determined when impingement was not detected.

Conclusion. The model quantitatively characterized impingement of the anterior cruciate ligament against the intercondylar notch in 3-D space.

Relevance The approach helps us better understand anterior cruciate ligament injury mechanisms in individual knees. Clinically, the model could potentially be used to analyze subject-specific potential/actual anterior cruciate ligament impingement based on the subject’s MRI scans.     

平片与MRI在胫骨髁间隆突撕脱性骨折中的诊疗价值

目的评价X线平片与MRI检查对胫骨髁间隆突撕脱性骨折的诊疗价值。方法回顾性分析32例胫骨髁间隆突撕脱性骨折患者X线及MRI影像资料，所有骨折病例均经关节镜证实。X线摄片采用膝关节正侧位，部分加摄斜位；MRI检查采用横断位FSE-T2WI，斜矢状位SE—T1WI、FSE-T2WI、STIR及冠状FSE-T2WI、梯度回波脂肪抑制序列扫描，检查时患者取仰卧位。结果X线平片确诊28例（87．5％），漏诊4例（12．5％）；MR确诊32例（100％）；经X线确诊的患者中，MRI检查均合并周围其他结构的损伤（28／28），其中交叉韧带损伤26例，半月板损伤7例，侧副韧带损伤4例，骨挫伤26例，其他部位的骨折6例；X线漏诊的患者中，合并交叉韧带损伤3例，半月板损伤1例，骨挫伤2例。结论胫骨髁间隆突撕脱性骨折通常合并周围其他结构的损伤，经X线平片确诊的病例可直接行关节镜诊疗：疑似髁问隆突骨折的患者应行MR检查，为临床诊疗提供有效的影像资料。     

关节镜下微创治疗对胫骨髁间棘骨折的疗效

目的 探讨关节镜下复位不同内固定方法治疗胫骨髁间棘撕脱性骨折的疗效.方法 采用关节镜下治疗胫骨髁间棘撕脱性骨折83例,其中Ⅱ型27例,Ⅲ型38例,Ⅳ型18例.在关节镜监视下行骨折复位、利用前交叉韧带胫骨导向器准确确定骨床上的钻孔位置;于胫骨结节内下部经皮向关节腔钻入一个骨隧道;采用双股5号尼龙编织缝线套扎前交叉韧带基底并经骨隧道引出关节外固定于胫骨结节内侧门型钉上.结果 术后83例获得随访6～36个月,平均15个月.术后Lachman和抽屉试验均为阴性.X线片显示除2例骨块前缘有2 mm上撬外均为解剖复位,骨折全部愈合.膝关节活动均正常.结论 关节镜下复位及双股尼龙编织缝线套扎固定治疗胫骨髁间棘撕脱骨折,复位满意、固定可靠;该手术方法简便易行,创伤小,有利于膝关节功能恢复.     

Influence des facteurs intrinsèques anatomiques dans la rupture du ligament croisé antérieur : étude anatomoradiologique comparative

Studies of knee-joint anatomy and biomechanics have demonstrated to main intrinsic factor shaving a negative impact on the anterior-cruciate ligament (ACL): a narrow intercondylar notch and a weak tibial slope. The purpose of this work was to study tibial slope and width of the intercondylar notch measured on plain X-rays and magnetic resonance imaging (MRI) in knees with and without ACL tears.     

Ergebnisse verschiedener operativer Behandlungsverfahren bei vorderen Kreuzbandverletzungen im Kindes- und Jugendalter: Stabilität ohne Wachstumsfehler

Rupture of the anterior cruciate ligament (ACL) secondary to knee distortion injury is also quite common among children and adolescents. Whether reconstruction is indicated and which technique should be employed is still controversially debated. The surgical results obtained between 1982 and 1992 at the State Orthopedic Hospital Munich for 101 ACL ruptures diagnosed arthroscopically in patients with open physes were evaluated retrospectively. In 69% of cases the main finding of knee joint arthroscopy was the presence of hemarthrosis. In 84% the cause was a sports-related injury, particularly alpine skiing. 15% of the ACL injuries could only be confirmed/diagnosed by arthroscopy. Incorrect clinical diagnoses were found in up to 50% of cases, especially in the assessment of concomitant injuries. In 17 cases only diagnostic arthroscopy (mean age at surgery 12.3 years) was performed. Ten osseous refixations for fracture of intercondylar eminence (12.0 years) and 24 primary suture managements (14.2 years) were performed. In 36 cases, pedicled semitendinosus tendon augmentation was performed in addition to reinsertion (14.9 years). In 14 cases primary plastic repair was performed with the middle one-third of the patellar tendon (15.4 years). Fifty-four patients could be followed up for a mean 6.5 years after the operation by means of Lysholm, Tegner and IKDC scores. The clinical stability examination was supplemented by KT-1000 arthrometer measurement and radiography in two planes. Averaged for all surgical techniques, good and very good results were obtained in over 75% of cases. There were no major growth defects and rarely arthrotic changes. Suture management alone is not infrequently followed by re-ruptures; augmentations or plastic repair are thus the preferred procedures for patients aged 12 years or more. In patients with still wide open physes, the semitendinosus tendon should be preferred due to the possibility of obtaining and anchoring grafts. This study emphatically demonstrates in a large number of ACL stabilizations with open physes that very good stabilization is achieved but no growth defects are to be expected despite transepiphyseal drilling.