关节镜下半月板除与缝合治疗半月板红-白区纵形撕裂伤的临床研究.pdfVIP

目 录 中文摘要 ················································1 英文摘要 ················································3 引 言 ················································6 正 文 ················································8 1.材料和方法 ···········································8 1.1 一般资料 ·············································7 1.2 诊断标准 ·············································1 0 1.3 材料与工具 ············································10 1.4 手术操作方法 ··········································10 1.5疗效评估 ·············································11 2.结果 ·················································14 3.讨 论 ··········································· 15 4.结论 ·················································21 5.存在的问题和展望 ··································21 参考文献 ··············································23 附 图 26 综 述 ···············································28 致 谢 ···············································34 攻读学位期间发表的学术论文目录 ····················35 作者声明 ············································· 36 个人简历 ··············································37 2 中 文 摘 要 目 的：探讨关节镜下半月板部分切除术和关节镜下半月板缝合术 在半月板红-白区 （b 区）纵形撕裂伤治疗中的临床疗效，为临床治疗方 法的选择提供参考。 方 法：选择2006 年1 月～2008 年1 月位于膝关节半月板红-白区 （b 区）纵形撕裂伤的患者64 例，随机分成A、B 组。A 组 33 例，采取 关节镜下半月板缝合术，半月板缝合方法：均采用由外向内缝合，方法 为采用1枚 18 号腰穿针于半月板破裂部位相应的皮肤处向关节内穿刺， 关节镜监视下腰穿针通过半月板外周中部，穿过破裂口到游离缘进入关 节腔，拔出腰穿针内芯，将对折的长约 20cm 的0.8mm 细钢丝经腰穿针针 尾穿入关节内，关节镜监视下将钢丝从膝关节前内或前外侧关节镜入路 牵出，利用对折的钢丝将一条2-0 爱惜康缝线的一端牵出至膝关节内侧 或外侧皮外，同样的方法将爱惜康缝线的另一端牵出，两端抽紧于皮下 打结，根据半月板撕裂的范围进行重复穿针引线打结。B 组 31 例，采取 关节镜下半月板部分切除术，半月板部分切除方法：采用蓝钳将半月板 纵形撕裂伤的前后端连接部的游离缘咬断，并用蓝钳进行初步的修整， 然后用关节镜刨削系统及等离子刀打磨成形。术后均进行常规的功能康 复指导，出院后进行进行术后随访，随访时间12～18 个月，功能评定按 照Lysholm 膝关节评分表，对A、B 组术前术后膝关节功能进行对比，得 出各自评分值。 结 果：A 组男性19 例，女性14 例，平均随访时间14.6