前交叉韧带撞击综合征的关节镜下诊断和治疗_临床医学论文.docVIP

前交叉韧带撞击综合征的关节镜下诊断和治疗_临床医学论文 前交叉韧带撞击综合征的关节镜下诊断和治疗_临床医学论文 作者：田孟强，刘军，王立德，张宇，田铮巍，王磊，孙振辉，曹建刚，孙云波 【摘要】 ［目的］探讨膝关节前交叉韧带撞击综合征的发生机制、病理改变及关节镜下诊断与治疗。［方法］自2005年1月-2007年7月通过关节镜下诊断和治疗膝关节前交叉韧带撞击综合征28例,术前患者临床表现以膝关节伸直受限和膝前痛为主。关节镜下检查并确认引起前交叉韧带撞击原因：股骨髁间窝狭窄或骨赘形成19例，陈旧性胫骨髁间嵴骨折导致交叉韧带止点抬高4例，前交叉韧带囊肿3例，前交叉韧带重建术前交叉韧带止点选择不当2例。根据关节镜下检查结果选择相应的手术方式：股骨髁间窝成形术；股骨髁间窝成形+胫骨髁间嵴骨赘切除术；关节清理+交叉韧带囊肿切除术；交叉韧带胫骨止点复位重建内固定术。［结果］所有病例均获得随访，时间6～34个月，平均15个月，优19例，良4例，可4例，差1例，优良率82.1%。［结论］前交叉韧带撞击综合征是引起膝关节渐进性伸直受限和膝前痛的一个重要原因。关节镜的检查和镜下手术对其诊断和治疗有着极高价值。 【关键词】 关节镜； 膝关节； 前交叉韧带； 撞击综合征 Abstract：［Objective］To investigate the mechanism and pathologic changes of anterior cruciate ligament impingement syndrome as well as its arthroscopic diagnosis and treatment.［Method］From January 2005 to June 2007,28 patients with a history of anterior cruciate ligament impingement were diagnozed and treated arthroscopically.The patients clinical findings were mainly anterior patellar pain and limited knee joint.The reasons of anterior cruciate ligament impingement syndrome were indentified by routine arthroscopic examination: straitness of intercondylar notch or osteophytes formation in 19 cases,old avulsion fracture in the tibial intercondylar in 4 cases,anterior cruciate ligament cyst in 3 cases,incorrect tibial tunnel placement on reconstructed anterior cruciated ligament in 2 cases.Different surgical procedures were carried out according to the results of the examination: joint debridement and intercondyles plasty;intercondyles plasty and osteophytes resection;joint debridement and ACL cysts resection;ACL tibial eminence insertion reconstruction were performed.［Result］Twentyeight cases were followed for an average of 15 monthes（6-34 monthes）.The rate of good to excellent was 82.1%,recurrence was observed in 1 case.［Conclusion］The gradual constriction of the knee is mainly caused by the anterior cruciate ligament impingement syndrome.Arthroscopy is very valuable in diagnosis and treatment of anterior cruciate ligment impingement syndrome.I