关节镜在大转子滑囊炎中应用.docVIP

关节镜在大转子滑囊炎中应用【摘要】 目的 研究大转子滑囊炎的关节镜下治疗方法。方法 11例大转子滑囊炎患者，男8例，女3例。无明显诱因出现4例，碰撞所致5例，摔伤所致2例，滑囊最大10×12 cm，最小4×4 cm。全部病例在关节镜下手术切除滑囊，彻底冲洗后腔内注射稀释的地塞米松，加压包扎7~10 d。结果 随诊4~10月。最后随诊时除1例患者出现局部皮肤麻木外，其余患者均无疼痛、肿胀、感染、关节活动受限等表现，无复发病例。结论 关节镜下治疗大转子滑囊炎避免开放手术的弊端和并发症，并且可以早期功能恢复。 【关键词】 大转子；滑囊炎；关节镜 Treatment of trochanteric bursitis with debridement under arthroscopy ZHANG Shuai-gong, WANG Wei-ming, YU Xiao-chuan, LIU Zhi, YANG Meng. Department of Orthopedics, Affiliated Tengzhou Center Peoples Hospital JiNing Medical college, Tengzhou 277500，China 【Abstract】 Objective To study the treatment of trochanteric bursitis with debridement under arthroscopy.Methods Eleven cases(male8,femal3).4 patients had no history,5 were caused by crashing,2 were caused by falling.The biggest cyst was,an 10 12 cm and the small one 4 4 cm.The cyst wall and its contents were debrided and performed with a douch under arthroscopy,and injected with diluted hexadecadrol.Then,the wounds were dressed up with compression bandage in the following 7-10 days.Results The patients received a follow-up of 4 to 10 months.The results showed that one patient had local numbness of skin;the rest of them had satisfactory recovery without recurrence and wound infection, swelling,and the action of jointwas normal.Conclusion The treatment of trochanteric bursitis with debridement under arthroscopy has satisfactory therapeutic effect,which is simple and less complication. 【Key words】 Greater trochanta;Bursitis;Arthroscopy 大转子滑囊炎临床较为多见，发病时局部疼痛，粗隆部肿胀，其后方生理凹陷消失，局部可有压痛。治疗不当可迁延不愈。既往外科治疗采取开放手术，但术后容易发生瘢痕粘连，影响功能和美观。作者采用关节镜下手术的方案治疗大转子滑囊炎，取得十分满意疗效，现总结报告如下： 1 资料与方法 1.1 一般资料 2006年8月至2011年4月，关节镜下手术治疗大转子滑囊炎11例，男8例，女3例，年龄18~63岁，平均45岁。其中无明显诱因出现4例，碰撞所致5例，摔伤所致2例。病史1~4月，其中有5例患者行保守穿刺并囊内注射激素治疗无效。术前均行B超检查定位，滑囊最大10×12 cm，最小4×4 cm。全部均在关节镜下手术治疗。 1.2 手术方法 采用局部麻醉，选择滑囊下方内外侧两点入路，首先于滑囊内注入生理盐水冲洗液，使其充分膨胀，再在距囊肿底下缘1 cm处内外侧顺皮纹方向作长度为5 mm的切口，皮下潜行穿刺入镜及器械。术中所见：滑囊内纤维素沉积而成游离颗粒、粘连带及纤维条索等，可见滑囊壁增生肥厚。探查结束后以刨削器刨除滑囊内的纤维束沉积及其粘连带。滑囊后壁予以搔刮、刨削、切除直至见到正常组织；前壁的切除依据表面