[医药]关节镜下月板损伤的治疗.pptVIP

Resection（切除） 半月板移植 Allograft 半月板移植CMI (collagen meniscus implant) 我院目前开展关节镜手术 膝关节半月板成型、部分切术或者完全切除术 膝关节游离体摘除术 骨性关节炎膝关节清理术 膝关节前后交叉韧带重建术 膝关节关节炎、结核等 我院自2011年4月至今共开展约34例关节镜手术。其中有2例交叉韧带重建，其余均为关节 游离体、关节滑膜炎、半月板损伤等。 谢 谢 * 动物试验显示，半月板横裂如果裂口与周缘血运相通，10周后，肉芽组织可自周缘长入缺损内，浅层的滑膜可增长入半月板内，以协助完成修复过程。 半月板的神经随血管分布。 红区，红白区，白区 * 伸直时限前，屈曲时向后。 * 篮球：争球、切入投篮跳起或落地往往同时伴有身体旋转。 足球：急跑转向或急转急停；踢漏脚过伸挤压半月板。 体操：筋斗及各种下法落地时，中心不稳造成膝关节急剧闪动，屈伸扭转。 举重：起立时为增大力量双膝并拢呈外翻姿势。 冰雪项目：屈膝摔倒。 * * Only Grade III of IV signals correlate with a meniscal tear. Someone has found MRI to be less sensitive in diagnosing peripheral meniscus tears and not useful in evaluating the meniscus after repair because of the persistence of Grade III signals after proven meniscal healing. * Our philosophy in treating a meniscus lesion is to eliminate the symptoms stemming from the torn meniscus so that the athlete can return to sport. We also, however, look for the best long-term result with the lowest possible risk for degenerative arthritis. * At 10-year follow-up we have seen a 79% survival of repaired menisci. This broke down to an 11% retear incidence in stable knees and a 42% retear incidence in unstable knees. Of the patients with successful repairs, 85% had normal weight-bearing radiographs, documenting the biomechanical function of successfully repaired menisci. * Radial tears, however, did not result in a restoration of normal mechanical function, and this was attributed to the development to a fibroblastic scar that caused spread of the repair site. Results of partial meniscectomy for degenerative tears are not as good as those for traumatic tears (50- 60% vs. 80-95%, respectively). Athletes are able to return to unsupported ambulation in 1 to 3 days, return to strenuous training in 7 to 14 days, and return to competition in 3 to 4 weeks. Exceptionallly fit and well-motivated patients have been able to return to competition in 2 weeks or less. 水平撕裂 horizont