半月板全切除术远期疗效及其影响因素观察

本文对７３例半月板全切除术患者的远期疗效及其影响因素进行随访观察，随诊时间１０￣３４年，平均１９．４年，主观满意者５４．８％，结合物理检查和Ｘ线检查综合评定结果满意者５２．１％。统计学分析表明远期疗效与患者手术时年龄、术前病程及半月板切除侧别有显著相关性。客观检查手术膝退行性变８０．８％。作者认为半月板全切除术并非良性术式。     

膝关节镜下逆行半月板全切除术

膝关节镜微创外科技术的进展使许多半月板损伤得以修复，可以基本做到最大限度地保全半月板。但对于某些损伤程度较严重的半月板，仍须行全切除。因此，关节镜下半月板全切除术仍是目前治疗严重半月板损伤常用的方法。我所采用逆行半月板全切除方法治疗半月板损伤取得较好的临床疗效。     

60例半月板切除术患者的远期随访结果

本文作者报告了６０例半月板切除术的远期随访结果，随访时间为１０～３３年，平均１６．１年，结果优良率为５８．３％。统计学分析表明远期临床疗效与随访时间有显著相关性，但与术前病程无关。Ｘ线检查发现有８７．５％的患者膝关节出现明显的退行性改变，但退变程度与临床疗效并无明确联系。作者认为，半月板具有十分重要的生物力学功能，因此应尽可能避免半月板全切除手术。     

关节镜下外侧半月板全切和部分切除的短期疗效比较

目的比较关节镜下不同术式治疗外侧半月板损伤的短期疗效。方法210例(210膝)外侧半月板损伤在关节镜下行外侧半月板全切除或部分切除术,其中全切组120膝,平均年龄46.2岁(16～69岁);部分切除组90膝,平均年龄47.1岁(14～78岁)。Lysholm膝关节评分系统评价治疗效果并作手术前后的组间比较。结果术后获12～44个月(平均32.3个月)随访,Lysholm评分分别从术前的(56.2±16.6)分和(58.5±17.8)分提高至随访时的(92.9±10.3)分和(93.2±8.9)分,手术前后功能差异均有统计学意义(P<0.01),术后功能优良率达到96.67%和98.89%。两组患者间手术前后的Lysholm评分比较则均无统计学差异(P>0.05)。结论关节镜下治疗外侧半月板损伤是一种安全有效的方法,外侧半月板全切除术和部分切除术的短期治疗效果没有差异。     

外侧半月板切除术对膝关节影响的长期随访

[目的]观察外侧半月板切除术(lateral meniscectomy,LMT)对膝关节骨软骨的远期影响与并发症.[方法] 2009年6月开始对1981年2月～1996年8月本院收治的180例LMT病例进行随访,其中36例获得随访,男27例,女9例,18例为盘状半月板(占50％).手术年龄17 ～ 38岁,平均26岁.随访时间最长27年,最短13年4个月,平均19年8个月.[结果]36例中除1例19年来膝关节无疼痛及其他不适症状外,3例术后膝关节有“落空”感不稳,2年后消失,9例术后均有轻重不同程度的膝外侧疼痛,间歇发作,其余24例在术后8～11.5年出现疼痛症状,平均9.6年.到2011年6月随访截止,36例中CR片结果有3例出现膝内侧间隙变窄,外侧间隙较对侧也明显变窄,其余33例均有膝外侧间隙变窄或消失,关节镜下、大体直观均见膝关节股骨与胫骨外侧髁软骨缺损.因疼痛导致行走困难,25例行膝关节表面置换.[结论]LMT后膝关节周围不但发生适应性骨重构,而且最终必导致骨性关节炎.     

关节镜下半月板部分切除术与半月板成形术治疗中青年膝关节半月板损伤患者的疗效对比

目的 对比研究关节镜下半月板部分切除术与半月板成形术治疗中青年膝关节半月板损伤的效果及对患者预后的影响.方法 选取2018年2月至2020年1月收治的87例中青年膝关节半月板损伤患者,按治疗方案的不同分为A、B两组,分别施行关节镜下半月板部分切除术(45例)和半月板成形术(42例).比较两组患者手术相关指标和术后6个月...     

膝关节镜下半月板部分切除术疗效观察及护理

目的:探讨关节镜下半月板部分切除术的治疗效果及护理.方法:2009年9月～2011年01月,本院完成45例半月板损伤关节镜下手术,手术采用常规髌下前内侧和前外侧入路,根据镜下半月板损伤程度采用镜下技术进行生物学修复或部分切除,37例患者荻得随访,男19例(51%),女18例(49%),年龄28-35岁,,随访时间3～11个月.手术前、后采用Lysholm评分对膝关节功能进行评定,并应用配对t检验进行统计学分析.结果:手术前Lysholm评分为26～47分,平均(36.5)分,手术后提高至86～100分,平均(92.7)分.经过配对t检验分析,手术前后Lysholm评分有显著性差异(P＜0.05).结论:关节镜技术治疗半月板损伤具有创伤小、疗效好、并发症少、恢复快的显著优点.     

外侧半月板切除术对成人膝关节周围骨密度的影响

目的 观察外侧半月板切除术（lateral meniscectomy,LMT）对膝关节周围骨密度的影响.方法 选择术后患者128例,根据术后时间分为：0～1年组、2～4年组、5～10年组和11～17年组,设对应健侧为对照组,应用双能X线骨密度仪分别测量膝关节周围六个感兴趣区（region of interest,ROI）骨密度,并拍摄术侧膝关节计算机辅助的X线照片（computed roentgenograph,CR）.结果 0～1年组膝关节周围六个ROI骨密度均下降,R1～R4骨密度分别与对照组比较差异有统计学意义（P＜O.01）;术后2～4年组R1～R4骨密度均下降,而R5、R6骨密度有所增加,其中以R1、R3变化显著,分别与对照组比较差异有统计学意义（P＜0.01）;术后5～10年R2骨密度下降,但其余ROI骨密度增加,以外侧ROI骨密度增加明显,分别与对照组比较差异有统计学意义（P＜0.05）;术后11～17年组R1、R3骨密度下降,分别与对应健侧比较差异有统计学意义（P＜0.05）;CR片结果：部分正常,有的表现为骨小梁模糊、密度减低、可见局限性小片状骨质吸收区,有的表现为关节面内侧密度稍低、外侧密度增高,内髁小梁稀少、骨密度减低,股骨外髁骨质增生、轻度膝外翻,胫骨小梁减少、模糊但密度正常.结论 LMT术可引起膝关节周围适应性的骨重构.     

关节镜下膝关节半月板手术

１９９３年４月－１９９４年４月，在膝关节镜下部分半月板切除７８例次，全切除６例次，修正术１２例次，边缘缝合３例次，计９９例次，经过１年－１年半随诊，优良率达９２％，取得较好效果。认为膝关节镜下半月板切除术，是治疗瓣月板损伤较好的手术方法。     

Prognostic Factors of Mid- to Long-term Clinical Outcomes after Arthroscopic Partial Meniscectomy for Medial Meniscal Tears

BackgroudArthroscopic partial meniscectomy (APM) continues to be the popular treatment for meniscal tears, but recent randomized controlled trials have questioned its efficacy. To provide more evidence-based criteria for patient selection, we undertook this study to identify prognostic factors associated with clinical failure after APM for medial meniscus tears.MethodsMedical records of 160 patients followed up for at least 5 years after APM for medial meniscal tears were retrospectively reviewed. Demographic data (age, sex, and body mass index), radiographic variables (Kellgren-Lawrence [K-L] grade and hip-knee-ankle [HKA] angle), and clinical scores (International Knee Documentation Committee score, Tegner activity scale score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score) were recorded. Clinical failure was defined as the need for an additional surgical procedure (arthroscopy, osteotomy, or arthroplasty) or the presence of intolerable pain. Survivorship analysis with clinical failure as an end point was performed using Kaplan-Meier survival curves. Factors related to clinical failure were analyzed using a Cox proportional hazard model. Cutoff values were determined using areas under receiver operating characteristic (ROC) curves. Radiographic progression of osteoarthritis was analyzed using the chi-square test, and serial changes of clinical scores were analyzed using a linear mixed model.ResultsClinical success rates were 95.7% at 5 years, 75.6% at 10 years, and 46.3% at 15 years. Age, HKA angle, and K-L grade (p = 0.01, p = 0.02, and p = 0.04, respectively) were found to be significant risk factors of clinical failure. Cutoff values at 10 years postoperatively as determined by ROC analysis were 50 years for age (sensitivity = 0.778, 1−specificity = 0.589), grade 2 for K-L grade (sensitivity = 0.778, 1−specificity = 0.109), and 5.5° for HKA angle (sensitivity = 0.667, 1−specificity = 0.258). In patients who had clinical success until 10 years after APM, radiological osteoarthritis progressed gradually. However, the clinical scores of patients who achieved clinical success did not decrease significantly over the 10-year follow-up.ConclusionsThe poor prognostic factors found to be related to clinical failure after APM for a medial meniscal tear were patient age (≥ 50 years), preoperative K-L grade (≥ grade 2), and preoperative HKA angle (≥ varus 5.5°).     

影响关节镜下半月板切除术预后的多因素分析

目的评估年龄、性别、病程、手术侧别和范围五个因素对半月板切除术预后的影响。方法216例单纯一侧半月板损伤患者行关节镜下切除术,术后平均随访5.1（2.4-8.0）年。术后膝关节功能采用Lysholm-Ⅱ评分;X片骨关节炎程度用Fairbank标准分级,术后X片改变（ΔG）取手术前后X片分级的差值。先将五个因素对Lysholm-Ⅱ评分、ΔG作单因素分析,找出有影响的因素,再行Logistic回归分析,得出该因素对Lysholm-Ⅱ评分和ΔG的回归方程。结果病程与手术范围对术后Lysholm-Ⅱ评分和△G有显著影响。由回归方程推知病程越长、手术范围越大,Lysholm-Ⅱ评分等级低,△G改变大的概率越高。结论早期手术与最大限度保留正常半月板组织是保证半月板切除手术效果的关键。     

Results After Meniscectomy in 147 Athletes

The object of this study was to ascertain the consequences of meniscectomy performed because of meniscus injury sustained during sports. Out of 147 athletes meniscectomized from 1964 to 1973 a total of 142 were seen at follow-up. the median follow-up period was 4.25 (range 2.25–11.0) years. During the follow-up period 8 per cent (11/142) had further surgical treatment because of new knee injuries. At the time of follow-up, 15 per cent (20/131) of the patients who had undergone operation solely for the primary meniscus injury had given up sports because of knee complaints and 12 per cent (16/131) had restricted their sporting activities. There were no complaints in 46 per cent (60/131). in 79 per cent (56/71) of the patients who had complaints, these had started immediately after operation. the main trouble was a feeling of instability and pain on weight-bearing. the complaints correlated with the physical findings at follow-up. in 14 per cent (18/131) there was increased collateral instability of the knee. Considering also previous experimental studies, it is concluded that meniscectomy causes immediate functional changes in the knee which explain the complaints. There was no correlation between complaints and radiological osteoarthrosis.     

半月板切除术后膝关节晚期退行性变

对于半月板和切除术后膝关节晚期退行性发迹及其影响因素尚存在不少争论。本文报告了对４５例行半月板切除术患者１０－３３年的随访结果，有４０名可在Ｘ线平片上观察到地性发迹之表现，占８９％。统计学分析表明，膝关节退行性发迹与随访时间有关，外侧半月板切除较内侧半月板切除更易发生退变。     

Arthroscopic Partial Medial Meniscectomy: An Analysis of Unsatisfactory Results

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.     

Endoscopic Total One-Piece Medial Meniscectomy: Its Effect on the Medial Collateral Ligament

Meniscus specimens from 10 patients subjected to endoscopic total medial meniscectomy were examined for remnants of the collateral ligament. Very small amounts were found in the postero-medial area of the specimens. None exceeded 2 mm in length or breadth and could be found in only one of the sections. With our technique for endoscopic total meniscectomy the integrity of the medial collateral ligament is not violated and ligamentous instability can be avoided.     

Clinical Results after Design Modification of Lospa Total Knee Arthroplasty System: Comparison between Posterior-Stabilized (PS) and PS Plus Types

BackgroundLospa posterior-stabilized (PS) Plus type is a modified version of Lospa PS, in which the polyethylene insert shape is modified to reinforce stability and prevent patella-post impingement compared to Lospa PS. However, studies comparing the clinical and radiographic results of the two designs have not been reported yet. This study aimed to compare the clinical results of total knee arthroplasty (TKA) using the existing PS type and the modified Lospa PS Plus type.MethodsA retrospective study was performed on 558 knees of 342 patients who underwent TKA using the Lospa PS or PS Plus types and were followed up for at least 2 years. Cases were divided into two groups according to the implant used: 212 cases in the PS group and 346 cases in the PS Plus group. For clinical outcome assessment, knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Knee Society Score (KSS) were recorded before surgery and at the 2-year follow-up. Radiographic outcomes were evaluated according to the American Knee Society method. The incidence of postoperative complications and survival rates were compared between the two groups.ResultsBoth groups showed significant clinical improvement after surgery. The average KSS significantly improved from 53.4 points in the PS group and 52.3 points in the PS Plus group preoperatively to 91.3 points and 93.2 points after surgery, respectively (p < 0.001). The average WOMAC score improved from 50.4 points in the PS group and 52.3 points in the PS Plus group before surgery to 15.6 points and 14.8 points after surgery, respectively (p < 0.001). There was no significant difference between the two groups in ROM, the alignment of the lower limbs, and the implant position after surgery. The complication rates were also similar between the groups (p = 0.167).ConclusionsThe Lospa PS Plus model is a modified design that improves the post structure from the previous PS type. Compared to the PS type, the PS Plus type showed similar statistical results at 2-year follow-up and good clinical results. The short-term average survival rate was over 98%, showing promising results.     

屈曲挛缩畸形的膝关节置换术

目的：探讨屈曲挛缩畸形的膝关节行关节置换的方法及疗效。方法：收集膝关节屈曲挛缩畸形病例56例,63膝,行膝关节置换。分别记录术前术后膝关节畸形程度,HSS评分,活动范围。并进行比较。结果：所有病例获得随访,屈曲挛缩畸形均得到改善,膝关节HSS评分由术前20．7分提高到术后平均73．6分。膝关节活动范围由术前平均32．6°（0°～55°）提高到术后平均92．7°（80°～125°）。结论：晚期骨性关节病所致的屈曲挛缩畸形的膝关节行膝关节置换术,着重注意软组织松解,力线调整。疗效满意。