关节镜下膝关节急慢性训练伤的诊断分析

目的 探讨军训及运动中膝关节稳定装置急慢性损伤的临床诊断与镜下诊断及其病理改变的差异程度。方法 97例膝关节训练损伤患者通过关节镜观察进行诊断，分析急性及慢性膝关节损伤的诊断及病理改变差异程度。结果 急性损伤(受伤6周之内)33例，临床诊断误诊率：ACL9.1％，PCL3.0％，半月板12.1％，二联征及三联征分别为6.1％及3.0％。慢性损伤64例，临床误诊率：ACLI1.6％，半月板4.7％，二联征及三联征各为1.6％。急性损伤合并软骨退变损伤5例(15.2％)，慢性损伤合并软骨退变性损伤25例(39.1％)，其中慢性膝关节损伤中韧带损伤合并软骨损伤20例，占80.0％。结论 急性膝关节损伤，由于关节肿胀、剧痛，临床检查受限，误诊率较高，应及早行关节镜检查，以提高诊断率。关节软骨损伤与关节损伤后不稳有关。慢性膝关节损伤引起软骨损伤的合并症，明显高于急性期，病程越长，软骨损伤越重。疑有韧带损伤、关节不稳、半月板损伤的患者应及早行韧带及半月板修复，以减少继发性软骨损伤。

Diagnosis of acute and chronic injuries of knee by arthroscopy

Objective To compare the differences between clinical diagnoses of acute and chronic injuries of knee and arthroscopic ones, and to study the differences of pathologic changes between acute injuries of knee and chronic ones by arthroscopy. Method Arthroscopy was done for 97 patients with acute and chronic injuries of knee which had been caused in the military or athletic training to analyze the differences between clinical diagnoses and arthroscopic ones, and to study the pathologic changes between acute injuries and chronic ones. Results Of the 97 cases, 33 were acute injuries and 64 chronic ones. In cases of acute injury, the rates of clinical misdiagnosis were: 9.1%for ACL, 3.0%for PCL, and 12.1%for meniscus. The dyad and triad injuries were 6.1%and 3.0%respectively. In cases of chronic injury, the rates of clinical misdiagnosis were: 1.6%for ACL and 4.7%for meniscus. The bigeminal and triple injuries were all 1.6 %. 5 cases (15.2%) had acute knee injury associated with cartilage degeneration, and 25 cases (39.1%) had chronic knee injury associated with cartilage degeneration. Conclusions Arthroscopy should be done for acute knee injuries to ensure correct diagnosis. Since the cartilage injury is associated with the instability of the knee joint after the acute knee injury, the longer the knee injury the more damage to the cartilage. Active treatments, such as repair of ligament or meniscus, should be adopted for suspected patients with joint instability or lesion of ligament or meniscus.