股骨髁间窝撞击综合征的关节镜下诊断与治疗

目的 :对膝关节内股骨髁间窝撞击综合征的关节镜下诊断和治疗进行初步探讨。方法 :1991年 4月～1998年 11月关节镜下确诊膝关节内股骨髁间窝撞击综合征 4 3例 ,术前检查发现临床表现主要以膝关节髌前疼痛和关节伸直受阻为主。镜下见 :股骨髁间窝骨赘形成 16例 ,胫骨髁间嵴前缘骨赘形成 11例 ,胫骨髁间嵴前缘局限性滑膜软骨瘤病 2例 ,陈旧胫骨髁间嵴撕脱骨折 5例 ,ACL重建术后 2例 ,ACL损伤后断端残留 3例 ,ACL囊肿 4例。所有病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 39例(占 90 .7% ) ,随访时间 19～ 72个月。疗效评定 :优 13例 (占 33% ) ,良 19例 (占 4 9% ) ,中 5例 (占 13% ) ,差 2例 (占 5 % )。结论 :膝关节渐进性伸直障碍 ,大多是由于股骨髁间窝与ACL产生撞击以及胫骨髁间嵴本身或其前缘发生病变造成局部相对抬高而与股骨髁间窝顶部产生撞击所致 ,这类病变统称膝关节内股骨髁间窝撞击综合征。关节镜检查及镜下手术对其诊断和治疗有着重要的价值

Using Arthroscopic Surgery to Diagnose and Treat Femoral Intercondylar Notch Impingement Syndrome

Objective:To evaluate the efficacy of the arthroscopy in the femoral intercondylar notch impingement syndrome. Methods:Forty-six cases with femoral intercondylar notch impingement syndrome were diagnosed by arthroscopy between April 1991 and November 1998. Their clinical findings were mainly anterior patellar pain and limited knee joint.Arthroscopic findings were osteophytes formation ( in the femoral intercondylar notch or in the anterior marginal part of the tibial intercondylar eminence), regional synovial chondromatosis in the anterior marginal part of the tibial intercondylar eminence; old avulsion fracture in the tibial intercondylar eminence; completed anterior cruciate ligament (ACL)reconstruction; visible ACL residual stump and ACL's cyst. All the patients were treated by arthroscopy and some of them returned for visits for more than one year. Results: Thirty-nine cases (accounting for 90.7% of the total) were follow-up 19 to 27 months post-operatively.Excellent and good results were seen in 32 cases (82%). Conclusion:The gradual constriction of the knee joint is mainly cased by the impingement occurring in femoral intercondylar notch with ACL or tibial intercondylar eminence that is relatively elevated because of its pathologic changes. The above pathologic changes were called femoral intercondylar notch impingement syndrome. Knee joint arthroscopy is very beneficial to their diagnosis and treatment.