关节镜下半月板修整术及同时经皮钻孔减压治疗半月板损伤伴骨髓水肿症的临床效果

发布时间：2018-05-23 07:09

本文选题：膝关节 + 半月板　；参考：《南昌大学》2017年硕士论文

【摘要】：背景:骨髓水肿综合症(bone marrow edema syndrome,BMES)是一种特殊但诊断不足,好发于下肢的一类疼痛症状,病因及发病机制仍具争议,缺乏治疗金标准。因其病程可逆性,以往保守治疗在一定程度上可以缓解疼痛,改善症状,逆转病程,但治疗周期长且部分病例效果不理想。半月板损伤合并膝关节骨髓水肿好发于老年患者,常为内侧半月板损伤伴胫骨平台或股骨内髁的水肿,机理不明,可能与半月板损伤后机械应力异常引起BME有关。本文探讨关节镜下行半月板修整及同时经皮减压治疗半月板损伤合并膝关节周围BMES的效果。方法:选取南昌大学第四附属医院在2010年1月-2014年12月期间,收治的22例半月板损伤合并膝关节BMES患者,并由同一主刀医生给他们全部行关节镜下半月板修整及经皮钻孔减压治疗术,同时全部术后随访至24个月,分别比较术前和术后的疼痛视觉模拟评分(VAS)、Lysholm评分、磁共振影像表现和患者满意度。结果:术后1、3、6、12、24月随访:VAS均值均较术前有明显降低,差异具有统计学意义,术后1个月患者疼痛症状明显缓解,只有6例患者有感疼痛,疼痛难忍,影响食欲及睡眠,但尚能忍受;术后3个月及以后VAS评分均为6分以下,极少部分患者感疼痛并影响睡眠,但尚能忍受。术后半年至一年效果最好,术后2年部分患者VAS评分稍有增加;Lysholm均值均较术前有明显提高,差异具有统计学意义,术前有20例患者膝关节功能严重障碍,术后膝关节功能有明显改善,术后半年至一年膝关节功能改善效果最好,术后2年部分患者Lysholm评分稍有降低;术后6个月;磁共振上骨髓水肿征象完全消失,原水肿部位无明显疼痛,影像学与临床体征结果一致;末次随访时,18例患者对手术效果感到满意,患者满意度为82%。结论:对半月板损伤合并膝关节周围BMES的患者行关节镜下半月板修整及经皮减压术可有效的缓解疼痛症状、改善膝关节功能及骨髓内血运,可以作为临床上治疗半月板损伤合并膝关节周围BMES的一种有效治疗方案。
[Abstract]:Background: bone marrow edema syndromes (BMES) is a special but insufficiently diagnosed type of pain in the lower extremities. The etiology and pathogenesis are still controversial, and there is no standard for treatment. Because of its reversible course, conservative treatment in the past can relieve pain, improve symptoms and reverse the course of disease to a certain extent, but the treatment cycle is long and part of the case effect is not satisfactory. Meniscus injury combined with bone marrow edema of knee joint is common in elderly patients. Medial meniscus injury with edema of tibial plateau or femoral medial condyle may be related to BME caused by abnormal mechanical stress after meniscus injury. The effect of meniscus dressing under arthroscopy and percutaneous decompression on meniscus injury associated with BMES around the knee joint was studied. Methods: from January 2010 to December 2014, 22 patients with meniscus injury associated with knee joint BMES were selected from the fourth affiliated Hospital of Nanchang University. All of them were treated with arthroscopic meniscus dressing and percutaneous drilling decompression. All of them were followed up to 24 months after operation. The visual analogue scores of pain before and after operation were compared and the Lysholm scores were compared. MRI findings and patient satisfaction. Results: the mean value of VAS was significantly lower than that before operation at 12 months and 24 months after operation, and the difference was statistically significant. One month after operation, the pain symptoms of the patients were obviously relieved, and only 6 patients had pain and pain, which affected appetite and sleep. The VAS score was below 6 at and after 3 months after the operation. Very few patients felt pain and affected their sleep, but they could still bear it. Half a year to one year after operation, the VAS score of some patients increased slightly and the mean value of Lysholm was significantly higher than that before operation, and the difference was statistically significant. There were 20 patients with severe dysfunction of knee joint before operation. The knee joint function was obviously improved after operation. The effect of knee joint function improvement was the best from half a year to one year after operation. The Lysholm score of some patients decreased slightly 2 years after operation, and 6 months after operation, the bone marrow edema on MRI disappeared completely. There was no obvious pain in the original edema site, the results of imaging and clinical signs were consistent, and 18 patients were satisfied with the result of operation at the last follow-up, and the satisfaction of the patients was 82%. Conclusion: arthroscopic meniscus repair and percutaneous decompression for meniscus injury combined with BMES can effectively relieve the pain symptoms, improve the function of knee joint and blood circulation in bone marrow. It can be used as an effective treatment for meniscus injury associated with BMES around the knee joint.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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