膝关节镜下膝后侧腔室联合手术入路探析.docVIP

膝关节镜下膝后侧腔室联合手术入路探析 　 作者：刘杰， 王克力， 葛许峰， 潘刚 【摘要】 ［目的］探讨在关节镜下膝关节后侧腔室联合手术入路的重要性和可操作性。［方法］经过前内侧、前外侧和股骨髁切迹以及后内侧、后外侧和后纵隔内切口联合入路分别入镜、入器械，进行膝关节后侧腔室的探查和手术操作。［结果］216例（239膝）应用联合入路探查和治疗，其中5例膝因关节僵硬操作失败；175例膝用于治疗后侧腔室疾病，膝关节后侧腔室手术视野显著改善，探查和手术操作完善，均达到手术目的。1例膝内侧隐神经不全损伤，没有腘后神经、腓总神经、腘后血管、交叉韧带等重要组织损伤。［结论］膝关节后侧腔室病变较多，是检查和治疗的重要部位，并非“技术盲区”。这种联合手术入路，手术风险低，具备可操作性，可以提高手术效率和质量，可作为膝关节镜下常规手术入路。 【关键词】 膝关节； 膝后侧腔室； 切口联合入路； 关节镜 　　Combined entrances for the arthroscopic surgery of posterior compartment of the knee joint∥ 　　Abstract：［Objective］To study the feasibility and significance of a safe arthroscopic entrance technique to posterior compartment of the knee joint. ［Method］Exploratory surgery of posterior compartment of 239 knee joints was performed by arthroscope or its working instruments through the combined entrances of anteromedial, anterolateral, intercondylar notch, posteromedial, posterolateral and trans-septal. Their results were evaluated.［Result］With this technique, complete arthroscopic visualization of the posterior compartment of knee joint and arthroscopic procedures for this compartment could be easily performed in 216 cases (239 knees), except 5 cases with arthro-stiffness. There occurred 1 case of saphenous nerve injury but no complications such as injuries of popliteal neurovascular structures.［Conclusion］Combined entrances of posterior compartment of knee joint is a satisfactory approach for arthroscopic surgery of posterior compartment of knee joint and can give a high efficiency and quality of arthroscopic surgery for posterior compartment of knee joint. 　　Key words：knee joint posterior compartment; posterior combined entrances; compartment of knee joint; arthroscopic surgery 　　1 临床资料 　　2002年12月～2004年12月，共216例（239膝）膝关节镜检查治疗患者。除5例膝因关节僵硬，探查后侧腔室失败外，其它病例均接受了膝关节后侧腔室的探查操作。除了常规的腔室（髌上、内外侧隐窝、髁间窝、髌股关节等）检查治疗外，用于后侧腔室治疗175膝，另外69膝因为没有发现病变未采用后方入路（后内、后外和后纵隔内）。在治疗组中：半月板损伤97膝；滑膜炎21膝；各类关节炎23膝；PCL损伤（含胫骨止点撕脱骨折）11膝；游离体12膝；医源性异物3膝；其它8膝。1例膝内侧隐神经不全损伤，没有腘后神经、腓总神经、血管和交叉韧带等重要组织损伤。肌力与术前比较没有异常变化。各种入路