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关节镜下平行丝线法治疗前交叉韧带撕脱骨折

【摘 要】 目的 总结和分析关节镜下套管针引导平行丝线固定法修复前交叉韧带胫骨止点撕脱骨折的手术方法和疗效。 方法 2001 年1 月－ 2005 年12 月，收治前交叉韧带胫骨止点撕脱骨折17 例，其中男12 例，女5 例；年龄11 ～ 48 岁。新鲜骨折14 例，陈旧骨折3 例。按Meyers-Mckeever 分型，Ⅱ型5 例，Ⅲ A 型8 例，Ⅲ B 型4 例，术前Lysholm 膝关节功能评分57.3 分。术后在支具保护下行功能锻炼，定期随访，摄X 线片，观察、测量关节活动度及关节稳定性，术后行Lysholm 膝关节功能评分。 结果 全部获随访6 ～ 28 个月，平均12.7 个月。膝关节活动度恢复正常者13 例；不同程度受限3 例，但关节活动度均超过100º，为伴内侧副韧带损伤者；1 例陈旧骨折患者，术后过早去除支具功能锻炼，骨折未愈合，关节不稳，1 年后二次行前交叉韧带重建术，效果满意。16 例术后6 个月复查，X 线片示均解剖复位并骨折愈合，无关节不稳；Lysholm 评分97.8 分。 结论 关节镜下利用2 条平行线固定法治疗前交叉韧带胫骨止点撕脱骨折，对前交叉韧带及骨块损伤小，骨折复位简便，固定范围广且可靠，应力承载面积大，受力均匀，能防止骨折块碎裂、旋转或上撬。

关节镜下治疗胫骨髁间隆起撕脱骨折

ARTHROSCOPIC TREATMENT OF TIBIAL EMINENCE FRACTURE WITH FIGURE-OF-EIGHT SUTURE FIXATION TECHNIQUE

Objective To introduce the arthroscopic technique of figure-of-eight suture fixation for tibial eminence fracture, and to report its clinical results. Methods From January 1998 to June 2001, 21 cases of tibial eminence fracture were treated arthroscopically with figure-of-eight suture fixation technique. Active rehabilitation began one week after operation. The patients were followed up 6-24 months. The reduction and union of fracture, knee laxity, range ofmotion, and total knee function were evaluated. Results All fracture healed without displacement six weeks after operation. Three months postoperatively, no knee laxity or instability was detected in all patients; full range of motion of the affected knee returned in all patients when compared with the normal side. Six months postoperatively, the Lysholm knee score was 93.4±2.7. Conclusion Arthroscopic treatment of tibial eminence fracture with figure-of-eight suture fixation technique is reliable for fracture reduction , fixation and early mobilization. Arthroscopy is conducive to diagnoses and treatment of associated knee arthropathy, reduces the morbidity associated with arthrotomy, and restores knee function to the greatest extent when combined with figure-of-eight suture fixationtechniques. 

ARTHROSCOPIC DIAGNOSIS AND TREATMENT OF OSTEOCHONDRITIS DISSECANS OF ELBOW JOINTIN ADOLESCENT

Objective To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent. Methods From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbowjoint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80±10, the range of flexion and extend of joint 80±10°, the range of rotation of joint 100±5° preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extrapathway were given to explore and debride elbow joint and remove corpus liberum. Results All patients recovered daily life and work 7 to 12 dayspostoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12-5 months). The results wereexcellent in 7 and good in 4 according to HSS scoring system. At the final followup, the score of VAS was 32±15, showing statistically significant difference when compared with preoperation (Plt;0.05). The range of flexion and extend of joint was 110±10°，the range of rotation of joint was 120±5° postoperatively, showing statistically significant differences when compared with preoperation (Plt;0.05). Conclusion The elbow arthroscopy might be a reliable methodto diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma，quick recovery，significant improving function and less complications.

ARTHROSCOPIC SINGLE BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTRING TENDONS THROUGH POSTERIOR TRANS-SEPTUM PORTAL APPROACH WITH PRESERVATION OF REMNANT POSTERIOR CRUCIATE LIGAMENT FIBERS

ObjectiveTo introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. MethodsBetween June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. ResultsThe operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). ConclusionArthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.

Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome

ObjectiveTo investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome.MethodsBetween August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups (P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement.ResultsMedian operation time of group A was 50.5 minutes ［95%CI (49.3, 54.6)］, which was significantly shorter than that of group B ［88.5 minutes, 95%CI (76.5, 92.8)］ (Z=−4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups (t=−0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). The median subjective satisfaction score of group A was 2.0 ［95%(1.4, 1.7)］, which was better than that of group B ［2.0, 95%(1.6, 2.2)］ (Z=−2.480, P=0.013).ConclusionArthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang’s approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT OF KNEE BYUSING AUTOLOGOUS MULTISTRANDED SEMITENDINOUS TENDON

Objective To explore the therapeutic efficacy of arthroscopic reconstruction of anterior cruciate ligament (ACL) with autologous multistranded semitendinous tendon (ST). Methods From September 2000 to December 2004, 50 casesof ruptures of ACLs were diagnosed by clinical and arthroscopic examinations. There were 32 males and 18 females with an average age of 26.3 years (18-51 years). The locations were left knee in 31 cases and right knee in 19 cases. All patients had the history of knee joint injury. Arthroscopy showed 26 cases of rupture, 14cases of defect, 4 cases of avulsion and 6 cases of laceration. All patients were operated upon arthroscopically by using autologous multistranded ST. Plaster splints were used for 4 weeks after operation. The result was estimated by AO Yingfang’s standards and Lysholm knee scores. Results All patients achieved healing bythe first intention. The extension and flexion function was restored normal at 8-10 weeks. The patients were followed up averagely 1 year and 8 months (6.48 months). The results of drawer test and Lachman test were positive in 3 cases and suspiciously positive in 8 cases. The results were excellent in 23 patients, good in 18 and fair in 9. Lysholm knee scores were 4057±1068 preoperatively and 86.43±9.33 postoperatively, showing significant difference (P＜0.01). Conclusion Arthroscopy reconstruction of ACL with autologous multistranded ST may be one of the excellentmethods bringing less injury.

Arthroscopic reconstruction of anterior cruciate ligament with autologous ipsilateral peroneus longus tendon

ObjectiveTo investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction with the autologous ipsilateral peroneus longus tendon (PLT) under arthroscopy.MethodsA retrospective study was conducted on 35 patients with ACL rupture who underwent ACL reconstruction with autologous ipsilateral PLT under arthroscopy between October 2017 and October 2018. There were 19 males and 16 females with an average age of 43.4 years (range, 18-60 years), with 20 cases of left knee and 15 cases of right knee. The causes of injury included traffic accident in 14 cases, falling injury in 13 cases, and sports injury in 8 cases. The time from injury to operation ranged from 3 to 9 days (mean, 4.7 days). The patients suffered from swelling, pain, and limited mobility of knee joint before operation. The anterior drawer test, Lachman test, and pivot-shift test were positive before operation, whereas MRI was taken to confirm the ACL rupture. After operation, the patients were followed up every 3 months until the knee joint’s function returned to normal. MRI and X-ray films were used to observe the tendon-bone healing as well as the position of Endobutton suspension plate and hollow nail. The anterior drawer test, Lachman test, and pivot-shift test were conducted to observe the improvement of knee joint mobility. The functional improvements were evaluated by the International Knee Documents Committee (IKDC) score, Lysholm score, knee injury and osteoarthritis (KOOS) score.ResultsAll the 35 patients were followed up 12-18 months, with an average of 14.2 months. The incisions healed by first intention, and no complications such as infection, joint stiffness, and rerupture occurred. Postoperative anterior drawer test, Lachman test, and pivot-shift test turned to be negative of all patients. MRI showed that the ACL was continuous, and the tendon-bone in the distal femur tunnel and proximal tibia tunnel recovered well after operation. X-ray films showed that the positions of Endobutton suspension plate and hollow nail were stable. The IKDC, Lysholm, and KOOS scores at 3, 6, and 12 months after operation were significantly improved when compared with those before operation, and the scores were further improved with time after operation (P<0.05).ConclusionFor patients with ACL rupture, ACL reconstruction with the autologous ipsilateral PLT under arthroscopy has satisfactory effectiveness of quick recovery, good function, and great stability.

关节镜下后入路射频气化治疗腘窝囊肿临床观察

【摘要】 目的 探讨关节镜下后入路巨大腘窝囊肿(直径gt;5 cm)切除术的方法和临床效果。方法 2004年8月—2008年9月将39例腘窝囊肿直径＞5 cm分为两组。关节镜组20例行后入路关节镜下射频气化切除,不结扎囊肿蒂部；开放手术组19例行开放手术治疗,并结扎囊肿蒂部。结果 关节镜组术后平均住院时间、切口瘢痕大小均优于开放手术组(Plt;0.01)。39例患者随访18～36个月,平均26个月。两组术后复发率、术后临床评价囊肿分级改善率差异无统计学意义 (Pgt;0.05),且复发率与囊肿蒂部结扎与否无关。结论 关节镜下后入路射频气化巨大腘窝囊肿切除术操作安全、创伤小、痛苦少,术后瘢痕小,不影响美观,有利于早期功能锻炼。该术式与开放手术同样可靠,值得推广应用。

膝关节镜下松解术治疗膝关节功能障碍

【摘 要】 目的 总结膝关节功能障碍行关节镜下松解，以及术后康复方法及疗效。 方法 2002 年10 月－2006 年2 月，采用膝关节镜下松解术治疗膝关节功能障碍15 例，男11 例，女4 例；年龄25 ～ 56 岁。左侧9 例，右侧6 例。髌骨骨折7 例，胫骨平台骨折4 例，前交叉韧带断裂3 例，化脓性关节炎1 例。病程6 个月～ 3 年，平均1.5 年。膝关节功能障碍程度：伸膝0 ～ 10º，屈膝30 ～ 60 º；膝关节活动范围30 ～ 50 º。术后行关节腔冲洗，早期CPM 机功能锻炼，手法屈膝按摩。 结果 患者术后切口Ⅰ期愈合，无并发症。获随访1 ～ 3 年半，平均2 年。膝关节活动度: 屈110° ～伸0°者4 例，屈100° ～伸0° 者7 例，屈90° ～伸0° 者3 例，屈70° ～伸0° 者1 例。按KSS 评分标准，优11 例，良3 例，可1 例，优良率为93.3％。 结论 关节镜下行膝关节内松解，术后关节腔冲洗，为早期行膝关节功能锻炼创造了条件，有利于膝关节功能康复。