关节镜在单髁置换手术适应证选择中的价值

目的探讨关节镜技术在单髁置换手术适应证选择中的价值。方法对膝骨性关节炎拟行单髁置换的患者,采用关节镜对非置换间室进行检查和清理24例。年龄49～74岁,平均63岁。左膝9例,右膝15例。关节镜发现膝内侧关节间室的软骨和半月板损伤较外侧间室为重,软骨下骨裸露;由于外侧和髌股关节间室的软骨损伤程度较重,8例改为其他术式,选择单髁置换术16例。所有患者均进行关节镜下滑膜清理,单髁置换组镜下游离体取出4例、外侧间室半月板损伤修整4例、滑膜皱襞切除3例,髌骨向外倾斜伴软骨损伤、支持带松解和髌骨缘去神经化处理5例。结果单髁置换术后临床随访16例,平均14个月,术前Lysholm评分平均为67．5分,术后平均94分。功能评价：优12例,良2例,可2例。术后膝关节无疼痛,伸屈活动度正常,行走及生活质量均明显进步。结论膝骨关节炎拟行单髁置换者,采用关节镜检查有利于严格筛选手术适应证,对非置换间室病损,进行镜下清理有利于提高术后疗效。

The value of arthroscopic techniques in determination of indications of unicondylar arthroplasty

OBJECTIVE: To discuss the value of arthroscopic techniques in determining the indications of unicondylar arthroplasty. METHODS: Twenty-four patients with knee osteoarthritis, 14 males and 19 females, aged 63 (49 - 74), who were scheduled to undergo unicondylar arthroplasty were arthroscopically evaluated at the beginning of surgery. Arthroscopy showed injury of degree IV in the tibial and femoral cartilages in the medial compartment, severe abrasion of meniscus, and exposure of subchondral bone. Unicondylar arthroplasty was given up on 8 cases because of cartilage injuries in the lateral compartment, while the surgery was performed on the other 16 cases. All cases underwent synovium debridement, 5 of which underwent meniscus repair or partial meniscotomy in the lateral compartment, 4 underwent patellar reticulum releasing and peri-patellar denervation, 3 cases underwent synovium plica resection, and 4 cases had their loose bodies removed. Follow-up was conducted on 16 cases for 14 months on average. RESULTS: The average Lysholm score of the patients was 67.5 preoperatively and became 94 postoperatively. After operation, the symptoms of locking and pain were relieved. The functional evaluation result was excellent in 12 cases, good in 2, and fair in 2. CONCLUSION: Arthroscopic evaluation of intra-articular structures is valuable in determination of unicondylar arthroplasty indications. Arthroscopic procedures are valuable in minimizing preoperative symptoms.