膝关节镜下关节清理术加腔内注射透明质酸钠治疗骨性关节炎

目的探讨关节镜下清理术加腔内注射透明质酸钠治疗膝骨性关节炎的疗效。方法对78例88膝，膝关节骨性关节炎患者先用关节镜行清理术，待冲洗液清亮后向腔内注射透明质酸钠3ml。结果按疼痛、肿胀、关节活动度、步行能力、日常生活能力五项综合评分，随访8月-3年，优良率79．5％。结论关节镜下清理术可明确膝骨性关节炎的病变程度，有针对性的操作，同时注入透明质酸钠，可营养软骨，改变关节内环境，对治疗骨性关节炎具有肯定的疗效。     

膝骨性关节炎的关节镜微创手术治疗

目的 探讨膝骨性关节炎的关节镜微创手术治疗效果.方法 关节镜探查64例(68膝)膝骨性关节炎患者,通过关节镜微创手术进行镜下清理术治疗.结果 全部病例术后随访3～34个月,平均18.2个月.随访一年优良率81％;1～2年,优良率92％;2年以上者,优良率73％.结论 关节镜微创手术以其切口小,创伤小,疤痕少,康复快,并发症少等优点,为膝骨性关节炎提供了一种有效的治疗方法.     

关节镜下广泛与有限清理术治疗不同病变程度膝关节骨性关节炎疗效分析

目的比较关节镜下广泛清理术与有限清理术治疗不同病变程度膝关节骨性关节炎的临床疗效。方法选择32例行关节镜下广泛清理术治疗的膝关节骨性关节炎患者为观察组,选择30例行关节镜下有限清理术患者为对照组,比较2组患者关节功能优良率、Lysholm评分及视觉模拟评分(VAS)的差别。结果随访1年,观察组与对照组关节功能优良率分别为90.0%和91.4%,差别无统计学意义(P0.05);观察组Ⅱ级骨性关节炎患者Lysholm评分显著高于对照组(P0.05);2组Ⅰ级和Ⅲ级骨性关节炎患者Lysholm评分未见显著差别(P0.05);2组治疗后1年VAS评分差别无统计学意义(P0.05)。结论关节镜下广泛清理术与有限清理术治疗膝关节骨性关节炎临床疗效相当,但前者对于Ⅱ级病变患者疗效更为理想。     

关节镜下关节清理术对膝关节骨性关节炎的疗效观察

目的探讨关节镜下关节清理术对膝关节骨性关节炎（OA）的疗效观察。方法分析对膝关节骨性关节炎患者32例采用关节镜下关节清理术。结果对Ⅰ,Ⅱ度关节软骨退变病人疗效肯定,术后评估：优良率75%（术后2年）。Ⅲ度关节软骨退变病人术后远期效果较差。术前及术后远期比较关节清理术不能延缓X线上的骨性退变表现。结论关节镜有利于膝关节OA的早期诊断,对早期膝关节骨性关节炎患者有良好疗效,具有创伤小,恢复快,患者易于接受的特点。同时对于Ⅲ度关节软骨退变病人术后远期效果较差。     

关节镜下关节清理术对膝关节骨性关节炎的疗效观察

目的 探讨关节镜下关节清理术对膝关节骨性关节炎(OA)的疗效现察.方法 分析对膝关节骨性关节炎患者32例采用关节镜下关节清理术.结果 对Ⅰ,Ⅱ度关节软骨退变病人疗效肯定,术后评估:优良率75%(术后2年).Ⅲ度关节软骨退变病人术后远期效果较差.术前及术后远期比较关节清理术不能延缓X线上的骨性退变表现.结论 关节镜有利于膝关节OA的早期诊断,对早期膝关节骨性关节炎患者有良好疗效,具有创伤小,恢复快,患者易于接受的特点.同时对于Ⅲ度关节软骨退变病人术后远期效果较差.     

关节置换与关节镜下清理术后膝骨性关节炎患者尿液EKGPDP小肽与关节软骨退变的相关性

背景:目前诊断骨性关节炎的手段主要有影像学和关节镜检查,但都存在一定的局限性。寻找一种特异性、敏感性、诊断率高,可操作性强的诊断方式是目前急需解决的问题。目的:探讨膝骨性关节炎患者尿液中EKGPDP小肽水平与关节软骨病变严重程度之间的关系。方法:纳入2006-01/2008-04在广东医学院附属深圳福田医院骨关节外科行关节镜下关节清理术治疗患者45例,膝关节置换术患者15例。纳入同一时期性别年龄相匹配的40名健康志愿者为对照组。采用竞争性ELISA法检测受试者尿液中EKGPDP小肽水平并于半年后复查,以Ayral关节镜膝滑膜炎评分法和Outerbridge软骨损伤评分法评估膝骨性关节炎患者滑膜和关节软骨的病理变化程度。结果与结论:膝骨性关节炎患者EKGPDP小肽水平明显高于健康人(P0.001)。膝骨性关节炎患者的EKGPDP小肽水平与Outerbridge软骨损伤评分、体质量指数正相关;与Ayral膝滑膜炎评分无相关性(P0.05)。全膝关节置换术者半年后EKGPDP小肽水平,较置换前明显下降(P0.05),关节镜清理术患者EKGPDP小肽水平变化不明显(P0.05)。说明膝骨性关节炎患者尿液中EKGPDP小肽水平可以反映膝关节软骨损伤程度,可为膝骨性关节炎的临床诊断提供依据。     

关节镜治疗膝关节骨性关节炎的围术期护理观察

目的：探讨关节镜治疗膝关节骨性关节炎围术期的临床护理手段。方法选取我院2012年2月~2013年2月的关节镜治疗膝关节骨性关节炎的80例患者。通过对所有患者采用术前护理、术前准备、术中配合、术后的康复护理,总结护理经验和方法。结果对80例患者进行12个月定期随访,通过综合评分,优45例,占56.25%,良25例,占31.25%,可8例,占10%,差2例,占2.5%;优良率为87.5%。术后未见并发症。结论密切的病情观察和护理,及时系统的功能锻炼是保证关节镜治疗成功的关键,能够有效恢复患者膝关节功能,避免手术并发症的产生。     

关节镜在不同膝关节滑膜病变中的诊疗分析

目的观察关节镜在不同膝关节滑膜病变中的诊断、治疗作用,分析不同病变的临床疗效。方法选取50例关节镜下诊断、治疗的膝关节滑膜病变患者为研究对象,术前拟诊为类风湿性关节炎10例,色素沉着绒毛结节性滑膜炎11例,膝关节慢性感染5例,慢性非特异性滑膜炎12例,膝关节滑膜结核5例,半月板损伤4例,不明原因3例,记录关节镜对膝关节滑膜病变的诊治效果。结果关节镜结合病理检查结果,术后10例患者更正临床诊断,所有伤口均一期愈合,无严重并发症发生。出院后所有患者均获得随访,6例色素沉着绒毛结节性滑膜炎,2例类风湿性关节炎,1例滑膜结核,1例慢性非特异性滑膜炎术后复发,其余患者术后膝关节功能均获得显著改善,总有效率80.0%。结论关节镜检查有利于明确诊断,而且微创可彻底切除病变的滑膜组织,耐受性好。     

关节镜术后不同时点应用透明质酸钠和双醋瑞因治疗膝骨性关节炎的比较

目的研究膝关节骨性关节炎行膝关节镜清理术后不同时点联合应用透明质酸钠及双醋瑞因治疗的疗效。方法 2009年8月至2013年3月江苏大学附属金坛医院住院治疗的膝骨性关节炎患者共70例,根据入院时间先后顺序按照随机数字表法将70例患者随机分为2组,实验组35例,膝关节镜清理术后即刻于髌骨注射透明质酸钠,2 m L/次,1次/周,共注射5次,同时口服双醋瑞因胶囊,50 mg/次,2次/d,4周为1个疗程,共用药3个疗程。对照组35例,膝关节镜清理术后2周用药,药物治疗方法与实验组相同。两组患者术前、术后6周、术后6个月分别进行膝关节Lysholm评分和HSS评分优良率,Lysholm评分比较采用t检验,HSS评分优良率采用χ~2检验。结果术后6周,实验组Lysholm评分(78.49±7.33)分及HSS评分优良率94.3%,与对照组(75.71±5.71)分、88.6%相比,差异无统计学意义(t=1.765,P=0.080;χ~2=0.729,P=0.393);术后6个月,实验组Lysholm评分(73.89±7.20)分及HSS评分优良率91.4%均显著优于对照组(57.57±7.29)分、71.4%,差异有统计学意义(t=9.424,P=0.000;χ2=4.629,P=0.031)。结论术后即刻应用透明质酸钠和双醋瑞因治疗有利于膝骨关节炎关节镜下清理术后膝关节功能的近期康复。     

单髁置换术与胫骨高位截骨术治疗膝骨性关节炎疗效比较

目的探讨单髁置换术与胫骨高位截骨术治疗膝骨性关节炎疗效比较。方法自1998年3月~2005年5月,采用关节镜下清理关节联合胫骨高位截骨术治疗膝骨性关节并膝内翻患者65例(69膝)。手术均先行膝关节镜检查,重点评估外侧股胫关节病损情况,然后行镜下关节清理,最后行胫骨高位截骨术。2009年6月~2010年2月采用OXFord活动半月板单髁关节共治疗膝骨性关节炎患者23例25膝,疗效评定标准选用HSS膝关节评分系统。结果术后3年单髁置换与高位截骨评分无显著性差异。结论单髁置换与胫骨高位截骨对于膝关节单间室骨性关节炎都有较好早期疗效,术式选择应当遵循个体化原则,综合考虑年龄,性别,畸形程度,体重,对活动度要求,术后从事工作等。     

Autologous chondrocyte implantation for treatment of focal chondral defects of the knee--a clinical, arthroscopic, MRI and histologic evaluation at 2 years

To determine the efficacy of autologous chondrocyte implantation (ACI) in treating focal chondral defects of the knee, we reviewed the 2-year treatment outcome of ACI in 53 patients (72 lesions) through clinical evaluation, MRI, second-look arthroscopy and biopsies obtained. Improvement in mean subjective score from preoperative (37.6) to 12 months (56.4) and 24 (60.1) months post-ACI were observed. Knee function levels also improved [86% International Cartilage Repair Society (ICRS) III/IV to 66.6% I/II] from preoperative period to 24 months postimplantation. Objective IKDC score of A or B were observed in 88% preoperatively. This decreased to 67.9% at 3 months before improving to 92.5% at 12 months and 94.4% at 24 months post implantation. Transient deterioration in all these clinical scores was observed at 3 months before progressive improvement became evident. MRI studies demonstrated 75.3% with at least 50% defect fill, 46.3% with near normal signal, 68.1% with mild/no effusion and also 66.7% with mild/no underlying bone marrow oedema at 3 months. These values improved to 94.2%, 86.9%, 91.3% and 88.4%, respectively, at 12 months. At 24 months, further improvements to 97%, 97%, 95.6% and 92.6%, respectively, were observed. Second-look arthroscopy carried out in 22 knees (32 lesions) demonstrated all grafts to be normal/nearly normal based on the International Cartilage Repair Society (ICRS) visual repair assessment while core biopsies from 20 lesions demonstrated 13 grafts to have hyaline/hyaline-like tissue. Improvement in clinical and MRI findings obtained from second-look arthroscopy and core biopsies evaluated indicate that, at 24 months post-ACI, the resurfaced focal chondral defects of the knee remained intact and continued to function well.     

关节镜辅助下三联法治疗儿童髌骨固定型脱位的疗效观察

目的　探讨关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解,结合股内侧肌成形治疗儿童髌骨固定型脱位临床疗效。 方法　回顾分析2014年1月至2017年1月收治10例12膝儿童髌骨固定型脱患者资料,男6例8膝,女4例4膝;年龄为4~9岁,平均6.6岁。所有患者均采用关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解,结合股内侧肌成形治疗儿童髌骨固定型脱位,术后随访根据髌骨稳定度及Kujala 评分评定膝关节功能恢复情况。 结果　10例儿童术后获得6~18个月（平均随访12个月）随访。所有儿童末次随访髌骨稳定度满意,Kujala 评分由术前的（42.12±14.37）分增加到随访时的（95.68±9.42）分,差异有统计学意义（P＜0.05）。 结论　关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解,结合股内侧肌成形治疗儿童髌骨固定性脱位临床疗效满意,可以有效增加髌骨稳定性,改善膝关节功能,对骨骺不造成损害,是一种有效的治疗儿童髌骨固定型脱位的手术方法。     

膝骨关节炎关节镜清理后即刻与2周后注射玻璃酸钠的比较

背景：膝关节骨关节炎关节镜下清理后注射玻璃酸钠可以起到减轻术后疼痛、改善关节功能的作用,但在膝关节镜下清理术后何时注射玻璃酸钠却存在争议。 目的：研究膝关节骨关节炎关节镜下清理后向膝关节腔内注射玻璃酸钠的时间,术后即刻注射和术后2周抽吸关节积液后再注射,何时注射更有利于促进术后膝关节功能康复。 方法：应用前瞻性随机对照方法分析100例膝骨关节炎关节镜下清理术患者术后即刻注射和术后2周抽液后注射玻璃酸钠的临床资料,记录术前疼痛目测类比评分、Lysholm评分,术后6周疼痛目测类比评分,3个月时疼痛目测类比评分、Lysholm评分,比较两组患者术后膝关节功能近期康复的效果。 结果与结论：即刻注射和2周后注射组术前疼痛目测类比评分分别为(6.52±2.38)分和(6.54±2.37)分,两组比较差异无显著性意义;Lysholm评分分别为(43.44±16.18)分和(51.12±16.30)分,即刻注射组低于2周后注射组。即刻注射组术后6周疼痛目测类比评分为(3.20±2.46)分,显著优于2周后注射组(5.10±2.68)分;即刻注射组术后3个月疼痛目测类比评分(2.72±2.70)分,Lysholm评分为(80.58±15.63)分,均显著优于2周后注射组(4.72±3.07分)、(64.96±21.68)分。说明术后即刻注射玻璃酸钠更有利于膝骨关节炎关节镜下清理术后膝关节功能的近期康复。     

Oxford单髁置换术治疗老年膝内侧间室骨性关节炎早中期临床疗效

目的探讨Oxford单髁置换术治疗老年膝内侧间室骨性关节炎早中期的临床疗效。方法回顾性分析2015年7月至2019年7月在禹城市人民医院骨科行Oxford单髁置换术治疗老年膝内侧间室骨性关节炎52例患者资料,采用术前和术后膝关节功能(KSS)评分、视觉模拟疼痛(VAS)评分、膝关节活动度(ROM)评价疗效。结果患者均顺利完成手术,随访时间3~24个月。术后3个月时患者膝关节功能(KSS)评分、膝关节活动度(ROM)明显改善,视觉模拟疼痛(VAS)评分明显降低。术后6周出现肌间血栓1例,经抗凝治疗后吸收。术后6个月出现衬垫脱位2例,1例手法挤压复位,另1例更换加厚衬垫后效果满意。无切口感染、深静脉血栓形成、假体松动及骨折等并发症。结论Oxford单髁置换术具有创伤小、利于快速康复等优势,治疗老年膝内侧间室骨性关节炎早中期临床疗效满意。     

关节镜治疗青少年膝关节盘状半月板损伤的临床疗效

目的 探讨膝关节镜治疗青少年膝关节盘状半月板损伤的临床疗效。方法 选择2012年9月~2015年9月应用膝关节镜治疗的21例青少年盘状半月板损伤的患者,分析关节镜术后患者的症状及体征。采用Ikeuchi膝关节评分标准评定临床疗效并采用GraphPad Prism统计学软件进行统计学分析。结果 21例患者均获得随访,随访时间5~17个月,平均9个月,评定其中优15例,良3例,可2例,差0例,膝关节优良率为85.71%;术前和术后出院前1天及术前和末次随访时膝关节功能评分分别为（57.45±1.87）分、（93.0±0.95）分、(93.45±0.85)分,差异具有统计学意义（P＜0.05）,而术后出院前1天和末次随访时比较,差异无统计学意义（P＞0.05）。结论 膝关节镜治疗青少年膝关节盘状半月板损伤的临床疗效优良,可以借鉴应用。     

Patients with lateral compartment knee osteoarthritis during arthroscopy are at highest risk of subsequent knee arthroplasty

BackgroundArthroscopic treatment of knee osteoarthritis has declined, in part due to concerns with conversion to arthroplasty. Some studies have investigated the demographic predictors for conversion to arthroplasty, few have assessed the risk factors within the knee itself. Our aim was to analyse the demographics and anatomical wear features of a large cohort of patients undergoing knee arthroscopy.MethodsA retrospective analysis of 1760 cases spanning over 17 years undergoing knee arthroscopy was performed. Patients were 36 years or older at time of the index arthroscopy. Each patient received the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of all regions as well an estimate of the remaining meniscal percentage. Demographic factors as well as intraoperatively collected data were analysed as predictive variables for subsequent conversion to arthroplasty using a multi-step Cox regression analysis.ResultsA total of 102 patients (6.2%) were converted to arthroplasty. Age at arthroscopy (hazard ratio (HR) 1.073; 95% confidence interval (CI) 1.058–1.088) and ICRS grade of the lateral tibial plateau (HR 1.166; 95% CI 1.066–1.276) were statistically significant predicting variables for conversion to arthroplasty.ConclusionsThe results of this study indicate that higher ICRS grade of the lateral tibial plateau at arthroscopy is the most significant predictor for conversion to knee arthroplasty, with a hazard equal to an increase in age. The absence of these factors does not justify arthroscopic treatment of patients with knee osteoarthritis.Level of evidence: III.     

双膝骨性关节炎患者未行二期膝关节置换的影响因素

背景：双膝骨性关节炎患者,做单侧置换后,很大一部分患者未作二次对侧置换,有很多影响因素。 目的：双膝骨性关节炎患者一期选择性单侧全膝关节置换后未行二期对侧膝关节置换的影响因素分析。 方法：纳入初次一期单侧全膝关节置换的双膝骨性关节炎患者28例28膝,假体均采用施乐辉公司普通型,所有患者一期单侧全膝关节置换后1年内未行二期对侧膝关节置换。记录置换前后HSS评分、膝关节活动范围;同时对28例患者未行二期膝关节置换影响因素进行问卷调查。 结果与结论：2例失访,2例在外院行对侧膝关节置换,最终随访24例24膝,平均随访12.6个月(12-19个月)。膝关节活动范围与HSS评分置换后与置换前比较均显著增加,差异有显著性意义(P =0.007,P =0.409)。问卷调查分析影响患者选择二期手术因素,单因素随访结果围手术期疼痛是主因占到95%以上;多因素随访结果：围手术期的疼痛占95.8%,心理因素占87.5%,医院的软件条件占70.8%,3项原因平均占总因素的84.7%。说明24例24膝未行二期膝关节置换影响因素中置换后围手术期的疼痛、患者的心理因素及医院的软件条件占据主导地位。     

Anterior cruciate ligament reconstruction with autologous ipsilateral 1/2 peroneus longus tendon北大核心

BACKGROUND: Anterior cruciate ligament (ACL) injury is a commonly sport-induced knee joint injury that does serious harm to the knee stability. ACL reconstruction is a commonly used treatment method, but researches on 1/2 peroneus longus tendon (PLT) graft are rarely reported. OBJECTIVE: To investigate the clinical outcomes of removing the autologous ipsilateral 1/2 PLT under arthroscopy for ACL reconstruction. METHODS: 106 patients with complete ACL rupture in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from December 2010 to December 2014 were enrolled, and autologous ipsilateral 1/2 PLT was removed under arthroscopy for ACL reconstruction. At baseline, 3, 6 and 12 months postoperatively, the knee stability was evaluated manually through the anterior drawer test, Lachman test, and pivot-shift test, and the knee function was evaluated by Tegner activity scale, Lysholm and International Knee Documentation Committee scores. RESULTS AND CONCLUSION: Postoperative anterior drawer test, Lachman test, and pivot-shift test tests were negative in all patients. In terms of Tegner activity scale, Lysholm and International Knee Documentation Committee scores, there were significant differences at baseline and postoperative 3 months as compared with postoperative 6 months (P < 0.05); the scores at baseline and postoperative 3 months showed significant differences compared with 12 months postoperatively (P < 0.05); the scores showed no significant difference between 6 and 12 months postoperatively (P > 0.05). These results indicate that autologous ipsilateral 1/2 PLT is a good choice for ACL reconstruction under arthroscopy, achieving rapid and satisfactory functional recovery of the knee joint, which is not only minimally invasive and easy to operate, but also exhibits good therapeutic efficacy. © 2017, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

一端带骨块同种异体深冻下肢肌腱重建前交叉韧带的应用

背景：关节镜辅助下重建前交叉韧带的移植物及固定方法的选择存在很多争论,各种固定方法均有其优缺点。 目的：评估一端带骨块深冻同种异体肌腱股骨侧嵌入重建膝关节前交叉韧带的效果。 方法：纳入2008-01/2009-09 在承德医学院附属医院骨科就诊的15例关节损伤患者(15膝),经关节镜检查证实为前交叉韧带断裂,其中运动损伤7例,交通事故伤6例,摔伤2例。均于关节镜下行一端带骨块的同种异体腱前交叉韧带重建术,记录患者膝关节Lysholm功能评分、KT-1000测量值。 结果与结论：对15例患者随访12~24个月,均未发生血管神经损伤、排异、感染等并发症。 KT-1000测量值术前双侧膝关节前向松弛度差值为3~5 mm 4例(27%),6~10 mm 9例(60%),>10 mm 2例(13%);末次随访时0~2 mm 12例(80%),3~5 mm 3例(20%)。同时,Lysholm膝关节功能评分也由术前的(65.60±10.13)分提高到末次随访时的(90.93±4.06)分(P < 0.05)。说明嵌入骨块在重建膝关节前交叉韧带中可增加股骨侧固定的可靠性,治疗效果满意。     

A prospective randomised trial comparing intra-articular Hyalgan injection and arthroscopic washout for knee osteoarthritis

Thirty-eight patients with symptomatic knee osteoarthritis without mechanical symptoms were randomised after informed consent to receive either a course of intra-articular Hyalgan injections or an arthroscopic washout. The patients were prospectively assessed pre-intervention, 6 weeks, 3 months, 6 months and 1 year using a 10 cm visual analogue pain score, the Knee Society function score and the Lequesne index. There was no significant difference between the two groups at 6 weeks, 3 months, 6 months or 1 year. The use of intra-articular Hyalgan injections in patients with knee osteoarthritis without mechanical symptoms gives results comparable with arthroscopic washout. Hyalgan is an alternative to arthroscopy in this patient group. Further study is needed to confirm these findings and improve patient selection.