膝关节镜术后再手术原因分析  

Analysis for the re-operated causes after knee arthroscopy

作　　者：倪磊[1] 吕厚山[1] 陈坚[1] 

机构地区：[1]北京大学人民医院关节病诊疗研究中心,100044

出　　处：《中华骨科杂志》2004年第3期150-153,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨导致膝关节镜手术疗效差或术后复发的技术因素,以提高对膝关节病变的认识和手术技能。方法回顾性分析膝关节镜术后再手术特别是再次关节镜手术时的检查所见。1990年1月～2002年1月,由本人施行的2000余例膝关节镜手术中,有38例因初次膝关节镜术的适应证选择不当、疗效差或术后复发而再手术。38例患者于初次手术后3～108个月,平均(29.61±21.98)个月,进行再手术。初次手术年龄11～68岁,平均(45.8±12.9)岁。男12例,女26例;左膝13例,右膝25例。原发疾病包括骨性关节炎21例,滑膜炎7例,半月板损伤及其它病变10例。再手术的症状包括疼痛、机械性症状或肿胀。再手术方式仍优先选择关节镜,方法同初次手术。对于滑膜炎较严重者选择开放性滑膜切除术,对X线检查提示至少有两个间室关节间隙显著狭窄的年龄适宜的患者选择全膝关节置换术。结果再手术包括膝关节镜术24例,全膝关节置换术10例,开放性滑膜切除术4例。软骨剥脱、滑膜病变残留或滑膜炎复发、以及漏诊半月板损伤是再手术中见到的主要病变。9例重度骨性关节炎和1例类风湿关节炎行全膝关节置换术。1例骨性关节炎、2例色素沉着绒毛结节性滑膜炎和1例反应性关节炎行开放性滑膜切除术。术后至少随访6个月,疼痛、机械性症状和肿胀消失。Objective To review the improper technical care related to the unsatisfactory results and the recurrence after the first operative arthroscopy of the knee joint, so as to improve the knowledge and operative technique for the knee disorders. Methods The re-operated findings, especially arthroscopically, were analyzed retrospectively. Thirty-eight patients, selected from about 2000 cases, were corresponded with the following specific criteria, such as the inappropriate indication, poor outcome and recurrence. They all underwent re-operations after the first arthroscopy 3-108 months (average, 29.61±21.98 months) from January 1990 to January 2002, whose average age at the first operation was 45.8±12.9 years(ranged from 11-68 years). There were 12 males and 26 females; 13 operations at left knees and 25 at right knees. The original diseases consisted of osteoarthritis in 21, synovitis in 7, meniscus tears and the others in 10. The recurred symptoms were pain, mechanical weakness, and swelling. The arthroscopies were preferred as first choice, the open synovectomy had been selected only for the severe synovitis, and the total knee arthroplasty was indicated for those in appropriate age and with severe narrowness in at least two chambers of the knee shown by roentgenogram. Results The re-operations included the arthroscopy for 24 patients, the total knee arthroplasty for 10, and the open synovectomy for 4. Cartilaginous lesions, residual synovial pathology and missed meniscus tears were found as three main kinds of neglected pathology at second arthroscopy. Total knee arthroplasties were performed in 9 severe osteoarthritis and 1 in rheumatoid arthritis. One patient with osteoarthritis, 2 pigmented villonodular synovitis and 1 reactive synovitis underwent open synovectomy. Pain, mechanical weakness and swelling disappeared at least during 6 months follow-up period. Conclusion The clinical results of the knee arthroscopy are related to the indication selections, the natural histories of the diseases, and the surgical

关 键 词：膝关节镜术后 再手术 原因分析 膝关节病变 

分 类 号：R687[医药卫生—骨科学]