关节镜下选择性病灶清除术治疗慢性非感染性髌前滑囊炎  

Treatment of chronic non-infectious prepatellar bursitis by selective debridement of arthroscopy

作　　者：李浪[1] 田臻 谢林[1] 刘代忠 高峰[1] 黄奇[1] 李强[1] Li Lang;Tian Zhen;Xie Lin;Liu Daizhong;Gao Feng;Huang Qi;Li Qiang(Department of Orthopedics,Branch Hospital of Tibetan Office in Chengdu, Chengdu 610041, China)

机构地区：[1]四川大学华西医院西藏成办分院骨科,成都610041

出　　处：《中华关节外科杂志（电子版）》2018年第2期276-279,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的回顾性研究关节镜下选择性清理结合加压包扎治疗慢性非感染性髌前滑囊炎的治疗效果。方法 2011年1月至2015年12月四川大学华西医院西藏成办分院骨科共收治16例慢性非感染性髌前滑囊炎的患者,所有患者炎性指标正常,无关节感染病史,其中男12例,女4例,病程1月至13个月。入院后予以股神经阻滞+静脉麻醉+吸入麻醉复合麻醉,在囊肿的7点钟方向置入关节镜探查,根据探查发现病灶组织的位置建立入路,置入刨削刀对近端质地坚韧的组织使用髓核钳咬碎后再切除、吸尽。前方的病灶组织只做适当切除,不予止血。术后伸膝位支具固定,术后3周内禁止屈膝锻炼。疼痛评估使用疼痛视觉模拟评分(VAS),膝关节功能使用Lysholm膝关节功能评分系统,末次随访复查MRI。结果本组3例患者门诊随访,13例通过手机微信随访,随访时间12~21月,平均(16±5)月。术后4周患者主动屈膝均超过120°,平均活动度(131±10)°,疼痛VAS评分0~3分,平均(2.0±1.0)分。Lysholm膝关节功能评分:优14例,良2例,优良率100%。MRI显示髌前滑囊无积液。结论关节镜下清理治疗慢性非感染性髌前滑囊炎创伤小、疗效满意,是一种有效的手术方法;手机微信可用于患者随访。Objective To retrospectively study the therapeutic effects of selective debridement and pressure dressing under arthroscope for treatment of chronic non-infective prepatellar bursitis. Methods From January 2011 to December 2015,16 patients with chronic non-infectious prepatellar bursitis were treated in the department of orthopedics,Branch Hospital of Tibetan Office in Chengdu. All the patients had normal inflammatory index and no history of joint infection. There were 12 males and four females. The patient ’s history was one month to 13 months. Femoral nerve block combined anesthesia was performed. Arthroscopic exploration was performed with an arthroscopic probe placed at the 7 o ’clock direction of the cyst,and the approach was established based on the location of the lesion tissue. The tough tissue at the proximal end was cut by shaver,while a proper excision was performed to the distal lesion tissue without hemostasis. The knee joint was fixed with braces at extension position. Knee flexion exercise was forbidden in three weeks after the surgery. Visual analogue score（VAS） was used for pain evaluation at preoperative and postoperative period,and at final follow-up. The knee function was assessed by Lysholm knee function score system and MRI was performed at the last follow-up. Results Three patients were outpatient follow-up,13 cases were followed up by mobile We Chat. The average follow-up time was（16 ± 4） months. All the wounds were type I/class A healing;postoperative weight-bearing and flexion exercises began three weeks later. In four weeks postoperatively,the patients could cflex the knee over 120 °,the mean range of motion was（131 ± 10） °. VAS score was（2. 1 ±1. 0） on average. Lysholm knee function scores were excellent in 14 cases,good in two cases; the excellent and good rate was 100%. MRI showed that no effusion in the anterior bursa had. Conclusion Arthroscopic debridement for treatment of chronic noninfectious prepatellar bursitis has small wounds and satisfactory results

关 键 词：关节镜 髌骨 滑囊炎 清创术 

分 类 号：R687.4[医药卫生—骨科学]