关节镜测量尺指导下微骨折术治疗膝关节软骨损伤的临床近期疗效观察

目的:通过关节镜探查膝关节软骨损伤的状态并采用微骨折术治疗,观察微骨折术的临床疗效。方法:2009年9月~2012年12月我科对29例膝关节软骨损伤患者采取关节镜下微骨折术治疗。术中利用关节镜测量尺对缺损区进行测量,并在其量化指导下行规律打孔,进行微骨折治疗。手术前后进行膝关节Lysholm评分及VAS评分。结果:软骨损伤于股骨内髁和股骨滑车关节面最常见,分别占41.4%和27.6%;软骨损伤面积多数在1~3 cm2,占69%(20例)。术后平均随访17个月(10~33个月),膝关节Lysholm评分由术前平均43.8分提高到术后末次随访86.1分,VAS评分由术前平均7.5分降至术后末次随访2.2分。结论:当软骨损伤面积小于4 cm2,微骨折技术是治疗膝关节全层软骨损伤的一种安全有效的方法。     

关节镜辅助下双钢板治疗Schatzker V型胫骨平台骨折

目的探讨关节镜辅助下双钢板治疗Schatzker V型胫骨平台骨折的方法及疗效。方法自2009年12月～2011年7月收治Schatzker V型胫骨平台骨折患者12例,其中道路交通伤10例,高处坠落伤2例。所有患者均为闭合性损伤。施行关节镜辅助下双侧锁定钢板有限切开整复内固定治疗术。术后进行随访,Rasmussen膝关节功能评分。结果随访12～24个月,平均16个月。手术时间90～160min(平均120min),骨折愈合时间3～5个月,1例发生骨性关节炎,无感染、深静脉血栓形成及小腿骨筋膜室综合征等并发症发生。采用Rasmussen膝关节功能评分标准评定疗效:优6例,良4例,可2例;优良率为83.3%。结论关节镜辅助下微创治疗Schatzker V型胫骨平台骨折,具有获得良好复位、创伤小、容易处理关节内合并伤、术后功能锻炼早、恢复快、并发症少的优点。     

关节镜下经皮植骨螺钉内固定治疗胫骨平台SchatzkerⅠ～Ⅲ型骨折

目的：探讨胫骨平台SchatzkerⅠ～Ⅲ型骨折患者采用关节镜辅助下经皮植骨螺钉内固定治疗的临床效果观察。方法采用随机数字表法将我院2011年3月～2013年3月收治的45例胫骨外侧平台SchatzkerⅠ～Ⅲ型骨折患者分为研究组（23例）和对照组（22例）,研究组采用关节镜辅助下经皮植骨螺钉内固定治疗,对照组采用传统切开复位内固定治疗,比较两组患者的术中情况及术后疗效。结果随访6～12个月,所有患者伤口均一期愈合,无感染、愈合迟缓病例;研究组患者骨折愈合时间、Lysholm评分、雍氏评分均显著优于对照组（P＜0．05）;研究组的疗效分布、总优良率均显著优于对照组（P＜0．05）。结论关节镜辅助下经皮植骨螺钉内固定治疗胫骨平台骨折患者较传统切开复位手术具有更好的临床效果,同时缩短患者愈合时间。     

关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折

目的:探讨关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。方法:回顾性分析2008年10月至2011年9月的32例前交叉韧带胫骨止点撕脱骨折患者的病例资料,全部患者采用关节镜下经髌内侧入路导入空心钉进行骨折内固定,采用膝关节功能评分及影像学检查评估术后疗效。结果:术后膝关节侧位片螺钉与胫骨平台夹角平均为(48°±7.3°),随访8~32个月,平均18个月,骨折愈合平均时间为(6.5±0.6)周,术后8周Lysholm膝关节功能评分达到(90.5±1.7)分,随访终末期Lysholm评分达到(94.6±1.5)分。结论:采用关节镜下经髌内侧入路导入空心钉治疗前交叉韧带胫骨止点撕脱骨折,取得了良好的临床效果。     

关节镜下双克氏针张力带钢丝固定治疗胫骨髁间棘骨折

目的 探讨关节镜下自创双克氏针张力带钢丝治疗胫骨髁间棘骨折的临床效果.方法 关节镜下平行双克氏针张力带钢丝固定治疗胫骨髁间棘骨折21例.术后石膏外固定3～4 w,6 w后可扶拐负重锻炼,术后3个月后取出内固定物.结果 所有病例术后随访至6个月,通过功能评估,Lysholm膝关节评分平均达到95.24分.结论 关节镜下双克氏针张力带钢丝固定治疗胫骨髁间棘骨折,损伤小,固定可靠,避免了传统手术的缺点,术后膝关节功能恢复良好,是一种较为理想的治疗方法.     

关节镜下空心钉治疗胫骨髁间棘骨折15例疗效分析

目的:探讨关节镜下应用空心钉内固定治疗胫骨髁间棘骨折的手术方法及疗效.方法 对15例胫骨髁间棘骨折在关节镜监视下进行复位,使用空心钉内固定.结果 15例骨折均一期愈合,无移位.Lysholm膝关节功能评分平均93.8分(90-97分).结论:在关节镜监视下对胫骨髁间棘骨折复位直观、准确,应用空心钉固定可靠,手术效果满意.     

关节镜下撬拨复位治疗胫骨平台SchatzkerⅢ型骨折

目的探讨关节镜下撬拨复位经皮螺钉固定治疗胫骨平台SchatzkerⅢ型骨折的临床疗效。方法2007年8月～2009年4月对19例SchatzkerⅢ型胫骨平台骨折行关节镜下撬拨复位经皮螺钉固定术,同时予以充分打压植骨,处理合并损伤。结果术后随访6～24个月,骨折平均愈合时间3个月;采用Rasmussen膝关节功能评分标准分级：优13例,良4例,可2例,优良率89．5％。结论关节镜辅助下撬拨复位经皮螺钉固定治疗胫骨平台SchatzkerⅢ型骨折具有微创、复位精确、早期康复快等优点,可同时处理合并损伤,随访效果满意。     

关节镜下复位空心螺钉固定治疗股骨髁部B型骨折11例临床报道

目的:探讨关节镜引导下微创治疗股骨髁部B型骨折的临床效果及手术适应症。方法:自2009年3月～2011年3月,对11例(11膝)股骨髁部B型骨折患者进行关节镜引导下复位空心螺钉固定术,其中男7例,女4例,年龄平均34.5岁;将骨折依国际内固定研究会(AO)标准分类,B1型3例,B2型4例,B3型4例。清理关节腔后,在关节镜监视下牵引,用点式复位钳不断调整以复位骨折,镜下证实关节面分离<2 mm和骨折的软骨面平整后,打入导针,用空心螺钉固定。结果:全部11例患者均获得随访,平均17个月(10～27个月),术后复查X线片示骨折均解剖对位,术后6月骨折均达到骨性愈合,Lysholm膝关节评分平均为90分(83～95分),膝关节屈伸活动度平均为131°(120～140°)。结论:关节镜引导下复位空心螺钉固定股骨髁部B型骨折具有微创、可视、复位确切等优点,并对合并膝内损伤者具有明显诊治优势。     

胫骨平台骨折合并交叉韧带损伤的手术治疗效果分析

目的探讨影响胫骨平台骨折合并交叉韧带损伤手术治疗疗效的因素。方法对2003年1月—2006年6月期间在我院治疗有随访结果的28例胫骨平台骨折合并交叉韧带损伤病例的膝关节Rasmussen临床和放射评分进行分析。结果随访6个月~4年,平均21月,采用Rasmussen临床和放射评分方法,优良率分别为85.7%和82.1%。结论胫骨平台骨折合并交叉韧带损伤获得良好治疗效果的影响因素:(1)早期诊断;(2)恢复关节稳定性:韧带修补重建、骨折良好的复位和牢固的内固定;(3)术后适时制动及完善合理的康复治疗。     

关节镜辅助下微创治疗儿童陈旧性胫骨髁间前棘骨折

目的:观察关节镜辅助下行骨折复位、应用不可吸收缝线固定治疗儿童陈旧性胫骨髁间前棘骨折术后膝关节功能恢复情况并评价其临床疗效。方法:对我院在2013年1月~2016年1月在关节镜下复位、应用2#爱惜邦不可吸收缝线固定治疗的15例陈旧性胫骨髁间前棘骨折患儿临床资料进行回顾性研究,手术时患儿年龄为6~15岁,男10例,女5例;右膝9例,左膝6例。记录所有患儿术前、术后3个月的症状、体征、关节活动度及X线片检查结果,并对其膝关节功能予Lysholm膝关节评分和国际膝关节文献委员会(IKDC)评分。结果:15例患儿术后均获11.67±4.27个月随访。术后3个月复查X线提示均为骨性愈合,患膝关节活动度恢复满意。术后3个月Lysholm评分(95.8±3.34)、IKDC评分(92.08±2.04)值与术前Lysholm评分(52.12±5.77)(t=-28.62,P<0.01)、IKDC评分(47.33±4.29)(t=-39.01,P<0.01)相比显著提高。结论:关节镜辅助下行骨折复位、应用不可吸收缝线固定治疗儿童陈旧性胫骨髁间前棘骨折能获得较好的疗效。     

关节镜下应用不同内固定材料治疗胫骨髁间棘骨折的疗效分析

目的比较应用不同内固定材料治疗胫骨髁间棘骨折的临床疗效。方法将收治的胫骨髁间棘骨折患者3l例,按应用钢丝、空心螺钉为内固定材料分别分为A、B两组,根据膝关节功能（HSS）评分和Lysholm评分对膝关节的功能效果进行评估。结果所有病人均随访6～18个月,平均（11．4土2．8）个月。所有病例术后骨折均愈合,A、B两组的平均HSS评分分别为（90．8土2．4）和（91．5土2．0）,平均Lysholm评分分别为（91．1土2．3）和（92．4士1．9）,两组差异无统计学意义（P〉0,05）。结论关节镜下复位后钢丝或空心螺钉内固定治疗胫骨髁间棘骨折均疗效满意,术后膝关节功能良好。     

Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures

Arthroscopic reduction and internal fixation of tibial plateau fractures has been well documented over the last 15 years. Better visualization, less traumatic surgery, reconstruction of accompanying injuries and early mobilization have encouraged arthroscopic surgeons to use this technique more widely. With experience, surgeons became more comfortable in using arthroscopy-assisted surgery not only in split fractures of the lateral tibial plateau (41-B1) but also in more complex tibial and femoral fractures. In this study, 31 patients with intra-articular fractures of the lateral tibial plateau were operated on between 1991 and 1996. The fractures were classified as follows: x12 AO-type B1, x7 B2, x10 B3, x2 C3. Diagnostic arthroscopy and repair of soft tissue injuries was followed by arthroscopic reduction in all patients and supplemented with internal fixation in 29 patients. Postoperatively, an aggressive physical therapy regimen was performed with immediate mobilization and early partial weight bearing. All patients were examined for follow-up after 15-32 months (mean 25.1). In all cases the fractures were stable and allowed full weight-bearing. At follow-up, 25 patients had anatomic reduction. Anatomical reduction cannot be restored in all cases of open reconstruction because of cartilage defects. Fracture reduction using arthroscopic techniques is a suitable alternative for joint fracture repair because additional soft tissue damage can be minimized.     

Second-look arthroscopy after arthroscopy-assisted treatment of tibial plateau fractures

The only way to show the healing potential in hyaline cartilage after the treatment of tibial plateau fractures in humans is the second-look arthroscopy. Our aim is to examine the healing potential of the hyaline cartilage in tibial plateau fractures treated with arthroscopy-assisted surgery. We applied second-look arthroscopy to the 12 patients out of 52 who had tibial plateau fractures treated by arthroscopy-assisted surgery. The mean age was 41. The tibial plateau fractures were classified according to Schatzker classification. The period between the primary surgical treatment and second-look arthroscopy was on an average of 19 months. Step-off was detected in 3 out of 12 patients. Hyaline cartilage of nine patients who did not have step-off was found obviously on the fracture line. None of them had displacement. Three patients out of 12 were above 50 years old and the average follow-up period was 26 months. Grade II-III chondral defect was detected on the fracture line and femoral condyle in patients above 50 years. For patients below 50 years old, the follow-up period was 21 months and grade I-II chondral defect was detected on the fracture line and femoral condyle. Until now in literature, tibial plateau fractures have been evaluated clinically and radiologically, but in our cases we directly saw the lesion. Cartilage healing is limited in human beings. On the fracture line, cartilage defect continues, although anatomic reduction has been achieved. Moreover, if there is step-off, insufficient healing potential appears. Although we did not have enough cases, we can say that in tibial plateau fractures anatomic reduction is mandatory. Contrary to the common idea, step-off is not tolerated by hyaline cartilage.     

旋后内收型Ⅱ度踝关节骨折的治疗策略

目的 探讨及总结旋后内收型Ⅱ度踝关节骨折的治疗策略及经验.方法 2003年3月-2008年9月,对32例旋后内收型Ⅱ度踝关节骨折进行手术治疗,其中男21例,女11例;年龄21～76岁,平均44.5岁.其中3例为开放性骨折.采取前内侧入路暴露内踝垂直骨折线及胫骨远端内侧关节面,探查胫骨远端关节面及距骨软骨受损情况,对塌陷受损的胫骨远端关节面进行植骨以恢复其高度,内踝直视下解剖复位,清除关节内脱落的软骨碎片;外侧韧带撕裂损伤根据稳定性情况决定是否修复,外踝移位骨折根据骨折块的大小及移位程度选择内固定.X线片观察术后骨折愈合、内固定及是否伴骨性关节炎情况,测量踝关节活动度恢复情况,同时按Maryland后足评分系统对踝关节功能进行评估.结果 32例中23例获随访,时间6-47个月,平均27.9个月.1例术后5个月出现2枚螺钉突出皮下予取出,余X线片显示无内固定松动、断裂,骨折2.3～5.1个月(平均2.9个月)后均愈合,随访时间内未出现骨性关节炎表现,踝关节活动度背伸为6°～17°,平均13°;跖屈27°～46°,平均36°.按Maryland后足评估标准,评定优19例,良4例,优良率为100%.结论 了解及重视旋后内收型Ⅱ度踝骨折受伤机制,加强对胫骨远端内侧关节面高度、软骨及距骨关节面软骨受损情况的诊断及处理可有效减少骨关节炎等并发症的发生1前内侧纵行切口更有利于骨折及受损关节软骨面的暴露、关节腔脱落软骨片的清除、胫骨远端植骨关节面高度的恢复及内固定的放置.

Abstract：

Objective To explore the treatment strategies for grade Ⅱ supination adduction ankle fracture. Methods From March 2003 to September 2008, 32 patients with grade Ⅱ supination adduction ankle fractures were treated surgically. There were 21 males and 11 females, at a mean age of 44.5 years (range, 21-76 years). Three patients had open ankle fractures. Anteromedial approach to the medial malleolus was taken to expose the vertical medial malleolus fractures and tibial plafond for exploring damage to distal articular surface of the tibia and that to cartilage of the talus. Open reduction and internal fixation with impaction of the articular fragment and possible bone grafting were applied to restore the height of the collapsed tibia. Medial mallcolus fractures were anatomically reduced and the intra-articular cartilage debris removed under direct vision. Repair of the lateral ligament injuries was decided acoording to the stability of the ligament. Different internal fixation was chosen according to fracture displacement of the block size and degree of lateral malleolus fractures. Fracture union, internal fixation and osteoarthritis were detected by X-ray examination. The range of ankle motion was measured. Maryland foot score was taken to assess the ankle function.Results Twenty-three patients were followed up postoperatively for a mean period of 27.9 months ( range, 6-47 months). Two prominent screws were removed from one patient five months after operation because of loosening. Bony fusion was achieved in all patients after an average period of 2.9 months ( range, 2.3-5.1 months). X-ray examination revealed no other internal fixation loosening or osteoarthritis. The average range of motion was 13 degrees of dorsiflexion (range, 6-17 degrees) and 36 degrees of plantarflexion (range, 27-46 degrees). According to Maryland foot score, ankle function was excellent in 19 patients and good in four, with excellence rate of 100%.Conclusions Understanding injury mechanism of supination adduction ankle fracture, strengthening the diagnosis and treatment of damage of tibial plafond articular surface height, cartilage and talar articular surface cartilage can effectively reduce the incidence of complications such as osteoarthritis. Anteromedial incision allows excellent exposure of the medial tibial plafond for clearance of intra-articular cartilage pieces, recovery of distal tibial articular surface height and placement of internal fixation.     

开窗植骨钢板内固定治疗胫骨平台塌陷骨折远期随访

目的研究开窗植骨钢板内固定术治疗胫骨平台塌陷性骨折10年以上的远期疗效。方法 1997年9月—2001年1月,采用开窗植骨钢板内固定术治疗胫骨平台塌陷性骨折101例,分析膝关节的Kellgren-Lawrence X线分级和Lysholm膝关节功能评分,研究骨折Schatzker分型、性别、年龄和植骨方式对关节功能的影响。结果 Schatzker分型越高,KellgrenLawrence X线级别分布越高(P<0.01),膝关节的Lysholm功能评分越低(P<0.01);男、女两组间Kellgren-Lawrence X线分级差异无统计学意义(P>0.05),但男性组的lysholm膝关节功能评分高于女性组(P<0.01);年龄越高,Kellgren-Lawrence X线级别分布越高(P<0.01),膝关节的Lysholm功能评分越低(P<0.01);自体髂骨植骨与同种异体骨植骨两组间Kellgren-Lawrence X线分级和lysholm膝关节功能评分均无统计学意义(P>0.05)。结论开窗植骨钢板内固定术治疗胫骨平台塌陷性骨折,可获得满意的远期疗效,骨折的Schatzker分型、性别、年龄是影响膝关节远期功能的主要因素,骨移植方式对膝关节功能无明显影响。     

侧后方入路钢板内固定治疗胫骨平台后髁骨折

目的探讨侧后方入路钢板内固定治疗胫骨平台后髁骨折疗效。方法对14例胫骨平台后髁骨折采用后内侧或后外侧入路切开复位钢板内固定治疗,观察其疗效。结果 14例随访12～24个月(平均15.2月),优10例,良3例,可1例。结论采用侧后方入路可充分暴露胫骨后平台后髁,直视下方便复位,结合钢板支撑内固定是治疗胫骨平台后髁骨折的一种有效方法。     

Anterior cruciate ligament reconstruction using autografts and double biodegradable femoral cross-pin fixation: functional,radiographic and MRI outcome after 2-year minimum follow-up

Double biodegradable cross-pins are increasingly used for femoral fixation in arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL). There are no studies combining functional outcome analysis, radiographs and magnetic resonance images (MRI) to evaluate this technique. The authors examined 45 patients after ACL reconstruction using double biodegradable femoral cross-pin fixation and biodegradable tibial interference screw fixation with a minimum follow-up of 24 months. Clinical evaluation included International Knee Documentation Committee (IKDC) and modified Lysholm score. Radiographic analysis included standard X-rays in anterior–posterior and lateral views and Telos stress device measurements. MRI was analyzed to obtain information about hardware, intra-articular graft, osseous graft-integration and cartilage. IKDC score revealed 28 (62.2%) patients with normal knee function (group A), 15 (33.3%) patients with nearly normal (group B) knee function and 2 (4.4%) patients with abnormal knee function (group C). The Lysholm score was 94.6 (±7.2) in the operated knee and 98.8 (±7.4) in the non-operated knee. Mean Telos stress device values were +4.6 (±2.6) in the operated and +3.9 (±2.4) in the non-operated knee. MRI showed an intact intra-articular graft in all but one patient. Complete femoral graft integration was seen in 88.9% and complete tibial graft integration in 86.7%. Biodegradable cross-pins were partially or fully visible in all patients. The biodegradable tibial interference screw was fully visible in 16 (35.6%) and partially visible in 20 (44.4%) patients. Thirty-one (68.9%) patients showed signs of cartilage degeneration on MRI at follow-up. The graft fixation with double biodegradable pin fixation appears to be a reliable technique for ACL reconstruction providing a stable close-to-joint graft fixation.     

青少年急性膝关节软骨损伤的MRI表现

目的 分析青少年急性膝关节软骨损伤的MRI表现.方法 回顾性分析53例(年龄4~27岁)在1个月内有膝关节损伤病史,且经关节镜手术证实的急性膝关节软骨损伤的MRI表现,重点观察软骨、软骨下低信号线和软骨下骨髓的改变.结果 MRI共发现69处软骨损伤,其中髌骨25处,股骨外髁22处,股骨内髁11处,股骨滑车2处,胫骨平台9处.单纯软骨骨折46处,包括软骨全层断裂22处、软骨部分断裂20处及裂隙状软骨骨折4处.骨软骨骨折23处,包括骨软骨撕脱骨折13处和软骨下骨质内陷10处.关节内软骨性游离体6例,骨软骨游离体13例.结论 MRI是急性软骨损伤最好的无创性检查方法.     

AO解剖钢板治疗严重胫骨平台骨折

目的 探讨应用AO解剖钢板治疗严重胫骨平台骨折的临床疗效.方法 对45例严重胫骨平台骨折的治疗情况进行回顾性分析.全部患者均采用AO解剖钢板内固定,同时根据伤情进行植骨,处理合并的半月板、副韧带和血管损伤;并采用HSS膝关节功能评分系统评估术后膝关节功能.结果 本组患者随访40例.骨折愈合时间为3～5个月;术后1年膝关节功能评定:优21例,良12例,可5例,差2例,优良率为82.5%.结论 采用AO解剖钢板治疗严重胫骨平台骨折,既能实现关节面的解剖复位,又能早期功能锻炼,可获得较为满意的治疗效果.