半月板损伤的治疗进展

本文就近年来膝关节半月板损伤的治疗进展作一综述。     

纤维蛋白粘合剂治疗半月板无血运区损伤的实验研究

目的　研究纤维蛋白粘合剂 (FS)对半月板无血运区损伤愈合的作用。　方法　选用健康成年青紫兰兔2 4只 ,首先在兔半月板上造成统一的无血运区损伤模型。随机将兔分成 2组 ,分别为空白对照组、FS治疗组。术后 2周、6周、12周分批处死动物 ,进行大体形态观察和组织学检查。　结果　空白对照组半月板裂口均未见愈合 ,FS治疗组能形成疤痕组织愈合。　结论　应用FS治疗半月板无血运区的损伤是一条有效的治疗途径     

自体骨髓基质细胞移植治疗兔膝关节半月板无血运区损伤

目的 观察自体骨髓基质细胞在体内分化为软骨细胞的能力及对半月板无血运区损伤修复的影响。方法 将体外培养的自体骨髓基质细胞收集后与纤维蛋白凝胶混合,植入４０只成年兔一侧膝半月板无血运区损伤的裂口内,另侧设空白对照或单纯纤维蛋白凝胶植放。分别于术后１（１２只）、２（１２只）、３（１５只）个月取村,行肉眼、光镜组织学观察。结果 术后２个月１２个膝半月板损伤处在量的软骨细胞并有胶原纤维形成,３个月１３个膝     

半月板损伤治疗进展

半月板损伤后应根据损伤类型、范围及患者的具体情况等来选择治疗方案。半月板部分切除术和修补缝合术是目前临床上应用较多的治疗方法,其适应证与优缺点各异。传统治疗方法的不足使研究重点转向半月板重建与替代。异体半月板移植在恢复半月板切除术后膝关节的生物力学平衡,降低骨关节炎发生率等方面取得一定的效果,移植成功率不断提高,但供体来源有限仍制约其推广。体外通过组织工程支架构建组织工程化半月板,利用细胞因子调控种子细胞的生长、分化和迁移并用于移植,有望为无法保留半月板的患者提供治疗的新方法。     

经关节镜半月板部分切除治疗半月板无血管区损伤

目的 分析关节镜下半月板部分切除治疗半月板无血管区损伤的手术疗效，提出较适宜的手术时机。方法 随访276例(侧)半月板无血管区损伤关节镜下部分切除的患者，从手术时间、镜下部分切除术后疗效进行分析、比较。结果 半月板损伤后15d～2个月组行半月板部分切除术后优良率达79％；2～4年组治疗术后优良率为57．2％。结论 半月板损伤应早期诊断、早期治疗；早期关节镜下部分切除无血管区损伤半月板的疗效明显优于晚期手术治疗。     

膝关节半月板损伤的治疗进展

由外伤、退行性病变、炎性疾患等原因所致的半月板损伤是常见疾病。在早期往往行半月板全切术。近年来，渐渐认识到半月板具有吸收震荡、扩大应力面积、增强膝关节稳定性的作用，而且半月板切除后的并发症骨性关节炎(OA)、膝关节不稳成为严重问题，对半月板损伤的处理日趋谨慎，基本原则是在去除临床症状的前提下尽可能多地保留有功能     

经关节镜半月板部分切除治疗半月板无血管区损伤的临床体会

目的 探讨经关节镜半月板部分切除治疗半月板无血管区损伤的临床效果.方法 选取2011年7月至2012年4月收治的30例半月板无血管区损伤进行关节镜下部分切除的患者,对这30例患者的临床手术治疗资料和效果进行回顾分析总结.结果 本组患者全部随访3个月,经膝关节功能疗效评价,优14例,良7例,中7例,差2例,优良率70.00％.术后有2例患者出现关节肿胀,经常规对症治疗恢复正常.按手术时间进行分组,在半年内进行手术的13例患者膝关节功能最佳,与其他组别比较差异明显,经统计学分析,P＜0.05,差异有统计学意义.结论 对于半月板出现损伤的患者应该及时诊断、治疗,通过早期及时的关节镜下切除治疗,患者的临床治疗效果均比较理想.     

半月板损伤的修复研究及关节镜的治疗进展

半月板损伤的修复研究及关节镜的治疗进展周勇唐农轩范清宇１半月板损伤的修复研究１．１早在１９３６年Ｋｉｎｇ就通过动物实验研究得出：半月板体部的撕裂不能愈合，但与关节囊相连的半月板边缘部的撕裂可愈合，半月板体部裂伤如向边缘部延伸到滑膜时有可能达到愈合。Ｂ...     

骨髓基质细胞移植修复半月板无血运区损伤的实验研究

目的比较自体与同种异体骨髓基质细胞移植对半月板无血运区损伤修复的影响。方法 40只成年新西兰大白兔随机平均分为 A、 B两组。 A组兔的骨髓基质细胞 (MSC)经体外培养后与纤维蛋白凝胶 (FG)混合,自体移植于其一侧的膝关节半月板缺损区,即 FG＋自体 MSC（自体移植组）;另一侧单纯植入 FG(FG植入组 )。于 B组兔的一侧膝关节半月板缺损区移植 FG＋同种异体 MSC(异体移植组 ),另一侧缺损不予修复 (空白对照组 )。分别于术后第 1、 2、 3个月取材,观察半月板损伤部位的组织形态学变化。结果 (1)自体移植组 :术后 1个月缺损区可见纤维组织,内有大量成纤维细胞;术后 2个月见大量软骨细胞并有胶原纤维形成;术后 3个月损伤区呈纤维软骨愈合。 (2)空白对照组 :术后 1～ 3个月缺损区始终未愈合。 (3)单纯 FG植入组 :术后 1～ 3个月缺损区可见纤维组织,内有少量成纤维细胞,没有软骨细胞生长,呈瘢痕样愈合。 (4)同种异体移植组 :与自体移植组所见大致相同,但有 3侧缺损区可见大量淋巴细胞浸润,胶原纤维少。结论骨髓基质细胞移植可促进半月板无血运区损伤的愈合,同种异体骨髓基质细胞移植修复半月板无血运区损伤发生免疫排斥反应的机率较低。     

半月板损伤的关节镜治疗进展

半月板损伤是骨科中常见的运动性损伤,青壮年的发病率最高,由于年龄、职业、劳动和运动强度的不同,其损伤的机会以及造成损伤的类型也不相同.膝关节是人体最复杂的关节,半月板作为稳定膝关节的重要结构之一,其重要性不言而喻.     

Repair of avascular meniscal injuries using juvenile meniscal fragments: An in vitro organ culture study

We investigated whether the implantation of juvenile allograft and minced meniscal fragments could improve the healing of avascular meniscal injuries, which cannot heal spontaneously. Concentric cylindrical explants were excised from the inner two‐thirds of swine medial menisci. The inner cylinder consisted of a “sandwich” structure, with minced juvenile meniscal fragments, juvenile meniscal columns, minced mature meniscal fragments, or mature meniscal columns implanted in the middle. The explants were cultured in vitro for 2, 4, or 6 weeks. Interfacial meniscal repair was assessed by histology, immunohistochemistry, biomechanical testing, and confocal laser scanning microscopy. Histology and confocal microscopy results revealed that tissue repair and cell accumulation at the interface were best at all time points in the juvenile meniscal fragments group, followed by the juvenile columns, minced mature fragments, and mature columns groups, respectively. At 6 weeks, the implantation of juvenile allograft and minced meniscal fragments increased the shear strength, peak force, and energy to failure in the peripheral interface. Picosirius red/polarized light microscopy and immunohistochemistry results showed concurrent expression of type I and II collagen in the interfacial repair tissue. In conclusion, implantation of juvenile allograft and minced meniscal fragments could increase the healing of avascular meniscal injury in vitro. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1514–1519, 2013     

Isolated meniscal repair in the avascular area

The authors present the results of a prospective cohort study carried out in young patients, to evaluate the outcome of meniscal repair in the avascular region of the meniscus. Forty five patients underwent either open (23 patients) or arthroscopic repair (22 patients) between 1982 and 1992. Seventeen men and eight women were included in the present study; their ages at the time of admission ranged from 16 to 27 years. They all presented with isolated longitudinal tears in the central avascular region of the meniscus. No patient with any kind of concomitant lesion was included in this series. The stitches were usually passed through the injured area and the synovium, and the knots were tightened outside the capsule. Twenty five patients of the total series, were subjected to a clinical examination in 1993, 9 to 54 months after meniscal suture. The Lysholm Knee Rating Score and the Tegner Activity Test were used. During 1999, these patients responded to a written questionnaire, based on the above mentioned rating scales. Among the 25 patients, there were 4 recurrences (16%), 2 fair results (8%) and one partial healing (4%). Eighteen (72%) patients, among which eight were treated using the arthroscopic technique, have shown favourable results, without any symptoms from the tibiofemoral joint, based on clinical examination and on the Lysholm Rating Scale and the Tegner Activity Test. When confronted with meniscal tears where there is doubt regarding the vascularity of the injured area, surgical repair in the avascular zone appears to provide a reasonable probability of healing, with good clinical outcome.     

Posterior meniscal root injuries

ABSTRACT — Meniscal root tears (MRTs) are defined as radial tears within 1?cm of the meniscal root insertion, or an avulsion of the insertion of the meniscus. These injuries change joint loading due to failure of the meniscus to convert axial loads into hoop stresses, resulting in joint overloading and degenerative changes in the knee. Meniscal root repair is recommended in patients without advanced osteoarthritis (Outerbridge 3–4), in order to restore joint congruence and loading and therefore to avoid the long-term effect of joint overloading. Several techniques have been described. Improved knee function has been reported after meniscal root repair, but there are still conflicting reports on whether surgical treatment can prevent osteoarthritis.     

Treatment of meniscal injuries in young athletes

The young, active patient with a meniscal tear poses a significant challenge for the surgeon. Multiple factors influence the treatment of meniscal pathology and the ultimate goal of meniscal surgery should be to remove only torn and nonfunctional tissue by limited meniscectomy or to repair amenable tears. The chondroprotective significance of the meniscus has influenced the current treatment of meniscal injuries in young athletes with the emphasis on repairing meniscus tears to include complex tears and tears in the avascular zone. Partial meniscectomy and meniscal repair techniques have provided good long-term clinical success and return to activity. The decision to debride versus repair a meniscus depends on tear pattern, location, and the patient's willingness to comply with postoperative restrictions. In patients with symptomatic meniscus deficiency, meniscal allograft transplant is an option that may provide pain relief but may not allow return to sports. The purpose of this article is to provide a succinct review of the diagnostic and management principles for the young, active patient with a meniscal tear.     

Meniscal rasping for repair of meniscal tear in the avascular zone.

We examined experimentally whether a longitudinal tear in the avascular zone of a rabbit meniscus can be healed by meniscal rasping. A full-thickness longitudinal tear 5-mm long was artificially created in the avascular zone of the anterior segment of both medial menisci. Meniscal rasping was then done on the femoral surface of the right meniscus from the parameniscal synovium to the inner segment including the tear. The left meniscus was left without further treatment as control. Two to 4 weeks after surgery, the hypertrophic synovium was observed invading from the parameniscal region to the injured portion. Eight to 16 weeks after surgery, the tear was almost completely healed. In contrast, neither hypertrophy of the synovium covering the tear nor healing was induced in the control meniscus. The mechanical test showed that there was a significant difference in the tensile strength and the stiffness of the injured portion between the rasped meniscus and the control meniscus. Meniscal rasping is easy to do, is effective, and causes few adverse effects with menisci. This procedure may be a treatment option for clinical cases of meniscal tear in the avascular zone for which we have no effective and clinically applicable methods at present, although further investigation is needed before clinical application.     

Application of laser Doppler technology to meniscal injuries

It has been recognized for many years that the vascular supply to the meniscus has been extremely important in the potential for healing of a repaired meniscus. Early experimental work confirmed that meniscal defects that communicated with the peripheral vascular network would heal if repaired. However, those tears that did not communicate with the vascular bed would not heal even if repaired. Unfortunately, there has been no clinically applicable technique for evaluating blood flow in the torn meniscus. Experimental procedures using laser Doppler flowmetry have shown this to be a precise and simple tool for the evaluation of meniscal blood flow. Applications of this technique in the clinical situation show great promise in enabling the surgeon to make a decision to repair or remove the torn meniscus based on the blood flow in the remaining vascular bed.     

膝关节半月板损伤的MR检查技术

MRI已成为诊断膝关节半月板损伤的首选方法。目前有多种脉冲序列及技术应用于膝关节损伤检查。本文就膝关节半月板损伤MR多种脉冲序列及检查技术的特点与应用情况进行综述。