关节镜下清理和钻孔治疗膝关节软骨退变的疗效分析

目的探讨关节镜下清理和钻孔治疗膝关节软骨退变的临床疗效。方法 2009年1月至2013年2月,87例膝关节软骨退变患者随机分为两组,A组含45例(56侧),予关节镜下清理术治疗;B组含42例(51侧),行关节镜下清理+软骨下骨钻孔术,术后予对症治疗。观察两组患者治疗后的效果。结果 A组治疗后6个月时优良率为64.29%,B组6个月后优良率为84.31%,差异有统计学意义(P<0.01)。两组患者术后均随访2年,B组术后6个月、1年和2年的优良率分别为89.29%、80.36%和75.00%,术后2年时的疗效显著低于6个月时(P=0.04)。结论关节镜清理+钻孔术治疗膝关节软骨退变疗效优于单纯关节镜清理术,但其疗效随时间延长而降低。     

关节镜下诊断与治疗膝关节内软骨损伤

目的：探讨关节镜在诊断膝关节内软骨损伤以及镜下手术治疗方面的作用。方法：1994年6月－1998年4月对膝关节外伤积血病例采用关节镜下检查,确诊为软骨损伤的病例41例。依据Johnson-Nurse分型,Ⅰ型17例,Ⅱ型24例,均行镜下手术治疗。通过1年以上随访行疗效评定。结果：获随访病例38例（占92．7％）,随访时间13－52个月。疗效评定：优55％,良31％,可11％,差3％。结论：关节镜下检查是诊断膝关节内软骨损伤的重要手段,对某些部的损伤,镜下手术可以完成切开手术同样的效果,且损伤小,恢复快,临床效果满意。     

膝关节滑膜脂肪瘤病的诊断与治疗

目的 探讨膝关节滑膜脂肪瘤病的命名、诊断及关节镜辅助治疗方法,提高对膝关节滑膜脂肪瘤病的认识.方法 回顾性分析2006年2月至2008年2月收治的9例滑膜脂肪瘤病病例资料,男4例,女5例;年龄32～71岁,平均51.1岁.9例均行病灶清理术,其中8例关节镜下手术,1例开放性手术.4例关节镜下表现为膝关节髌上囊滑膜大量、多发球形和绒毛状突起.绒毛饱满,呈浅黄色,严重时累及膝关节内侧室和外侧室;5例关节镜下表现为滑膜簇状增生,呈手指样.MRI显示关节腔积液,滑膜呈树枝状增生、肥厚.组织学检查显示绒毛最外层为两或三层滑膜细胞,绒毛间质由大量成熟的脂肪细胞构成.全部患者随访6～29个月,平均18.2个月.随访内容包括:病情主诉、膝关节活动度测量及膝关节功能Lysholm评分.结果 随访期间均未再发膝关节肿胀、积液.末次随访膝关节活动度111.67°±11.18°,Lysholm评分(72.44°13.93)分,二者与术前比较[101.11°±16.54°,(40.56±19.93)分]差异均有统计学意义(t值分别为3.447和6.728,P值分别为0.009和0.001).结论 临床上存在对滑膜脂肪瘤病的认识不足,常与膝关节滑膜脂肪瘤混淆.诊断主要依靠特异性的MRI表现、关节镜下特征及病理改变.对膝关节滑膜脂肪瘤病行关节镜下病灶清理术创伤小、恢复快.     

Imaging of Articular Cartilage

Since the advent of arthroscopy and MRI, clinicians have been able to directly image articular cartilage. Significant strides have been made to improve MRI technology to permit nondestructive imaging and assessment of articular cartilage. Development of new cartilage-specific MRI sequences and MRI techniques to evaluate cartilage matrix composition permit earlier diagnosis of cartilage injury and degeneration. Although the current standard for articular cartilage assessment continues to be visual assessment through arthroscopic surface imaging and probing, introduction of novel cross-sectional imaging technologies such as OCT will similarly augment the diagnostic capacity of arthroscopic assessment of articular cartilage. Continued development of new methods to image articular cartilage will enhance the ability of clinicians in identifying potentially treatable areas of early cartilage damage. Improved early diagnosis and treatment may lead to methods to prevent or delay the onset of disabling osteoarthritis.     

Diagnostics of degenerative meniscal tears at 3-Tesla MRI compared to arthroscopy as reference standard

Introduction The goal of this study was to evaluate the diagnostic performance of 3-Tesla MRI for the assessment of degenerative meniscal tears in clinical practice. Materials and methods In patients with chronic knee pain, a negative history of acute trauma and a mean age of 52 years, 3-Tesla MRI were performed a few days prior to arthroscopy. In 86 menisci, diagnostic values of 3-Tesla MRI for the detection of degenerative tears were evaluated using arthroscopy as reference standard. The MRI classification, for meniscus diagnostics, described by Crues was used. Results At arthroscopy, all tears identified (19 horizontal, 7 complex, 3 radial) were degenerative as confirmed by histological examination. MRI grade II lesions had a prevalence of 24% and a rate of 24% of missed tears, whereas grade I lesions were not associated with a torn meniscus at arthroscopy. For meniscal tears, (grade III) sensitivity and specificity of 3-Telsa MRI was 79 and 95% for both menisci, 86 and 100% for the medial meniscus, and 57 and 92% for the lateral meniscus. The best diagnostic performance was found for complex tears, horizontal tears showed relatively good results, poor results were documented for radial tears. Conclusion For the medial meniscus, where horizontal and complex tears were more prevalent, 3-Tesla MRI shows a higher accuracy than for the lateral meniscus. Particularly with regard to the medial meniscus, 3-Tesla MRI could be effectively used when a degenerative tear is suspected. Nevertheless, in regard to a remarkable number of false positive and false negative findings the diagnostic value of a 3-Tesla MRI investigation should not be overestimated.     

The use of axial reconstructed images from three-dimensional MRI datasets for morphological diagnosis of meniscal tears of the knee

Introduction In recent years, three-dimensional (3D) MRI has been utilized to detect meniscal tears and has displayed several advantages over 2D MRI. The diagnostic performance to discriminate the type of meniscal tears by 2D MRI (sagittal and coronal images) and axial images from 3D MRI datasets has not been reported yet. The aim of the present study is to evaluate the efficacy of the axial reconstructed images from 3D MRI datasets for the morphological diagnosis of meniscal tears of the knee.Materials and methods Seventy-four menisci in 37 patients who underwent arthroscopic surgery of the knee were studied. All patients were examined by 2D sagittal and coronal MRI and by axial images from 3D MRI datasets prior to surgery. First, we compared the diagnostic performance for meniscal tears by 2D sagittal and coronal MRI to that by axial images from 3D MRI datasets as judged by arthroscopic findings. Second, we compared the correlation of tear types presumed from 2D sagittal and coronal MRI to arthroscopy with those presumed from axial images from 3D MRI datasets to arthroscopy.Results For the diagnostic performance of meniscal tears on 2D MRI, the sensitivity, specificity and accuracy were 93.5%, 88.4% and 90.5%, respectively. On axial images from 3D MRI, the sensitivity, specificity and accuracy were 96.8%, 79.1% and 86.5%, respectively. Nine cases were false-positive on axial images, while 5 cases were false-positive on 2D images. Correlations to arthroscopy were 100% by both scans for longitudinal tears and discoid meniscus tears. Only 29% were correctly diagnosed by 2D sagittal and coronal images for radial tears, however, all radial tears could be correctly diagnosed by axial images. All horizontal tears were correctly diagnosed on 2D sagittal and coronal images, while none of the horizontal tears could be correctly diagnosed from axial images.Conclusion Axial images from 3D MRI datasets were useful in the diagnosis of radial tears, but two limitations are noted concerning the use of axial images. First, medial menisci should be carefully read on axial slices because of the relatively high rate of false-positives on medial menisci. Second, axial images cannot discriminate horizontal tears from other types of meniscus tears.     

四肢关节专用低场MR在膝关节疾病诊断中的应用

目的　通过对比四肢关节专用低场膝关节核磁共振图象 (MRI)与实体关节镜检查结果 ,探讨四肢关节专用低场核磁共振 (MR)检查在膝关节病变中的诊断价值。方法　自 2 0 0 1年 1 2月～ 2 0 0 3年 5月经四肢专用骨关节核磁共振检查 ,并为膝关节镜证实的 1 33例膝关节病损患者为其研究范围 ,综合对比两种检查结果。结果　四肢关节专用低场MR在膝关节病损中韧带损伤的诊断灵敏度高达 1 0 0 % ,半月板损伤最低仅为 5 5 88% (P <0 0 1 ) ;同样 ,韧带损伤诊断符合率最高 90 5 1 % ,软骨损伤最低为 82 0 9% (P <0 0 1 )。结论　核磁共振检查是临床诊断膝关节病变的一种重要、可靠的检查手段。通过采用MR特殊技术 ,提高病灶区的信号强度 ,使病变易于发现 ,不致发生错误或疏漏