再次膝关节镜手术的原因及对策

Knee re-arthroscopy causes and countermeasures after knee arthroscopy

目的:探讨再次膝关节镜手术的原因,提高关节镜诊治水平。方法:回顾1989年4月～2004年4月间再次膝关节镜手术检查所见,总结二次手术的诊断、治疗方法及治疗结果。膝关节镜下手术的第二(再)次关节镜下手术21例。男6例,女15例;再手术年龄18～62岁,平均32岁;距离第一次手术时间6d～18个月,平均6个月。外院转来17例,本院4例。结果:再次膝关节镜手术患者21例,术前、术中误诊11例,其中半月板损伤2例,类风湿性关节炎4例,前交叉韧带断裂2例,剥脱性骨软骨炎2例,髌骨脱位1例;术中处理不当10例,半月板4例,其它6例。21例患者均通过再次膝关节镜检获得进一步诊断及治疗。术后随访至少6个月,再次关节镜术后机械性交锁症状(13例)均消失,积液、肿、痛6例均得到控制后出院,感染及僵硬各1例恢复正常。结论:提高术前、术中对疾病的正确诊断率及关节镜技术是减少再手术发生率的关键。

Objective:To investigate knee re-arthroscopy causes and countermeasures after knee arthroscopy so as to improve the knowledge and operative technique for the knee disorders.Method:From April 1989 to April 2004, the re-arthroscopy findings were analyzed retrospectively to conclude the diagnoses,therapy and outcomes. Twenty-one cases whose average age at the second operation were 32 years(ranged from 18 to 62 years) underwent knee re-arthroscopy after the first arthroscopy 6 days to 18 months with an average of 6 months. There were 6 male and 15 female cases.Result:Among 21 cases with re-arthroscopy, 11 cases were misdiagnosed preoperatively and intraoperatively,including meniscal trauma in 2,rheumatoid arthritis in 4, rupture of anterior cruciate ligament in 2,dislocation of patella in 1 and osteochondritis dissecans in 2 cases; 10 cases were not treated properly in the procedure, including meniscal trauma in 4 and others in 6 cases.Twenty-one were diagnosed and treated properly by re-arthroscopy.The at least 6 months follow-up showed that all the knee mechanical lockings disappeared in 13 cases;infection and stiffness recovered in 1 case and hydrops, swelling and pain were controlled in 6 cases respectively.Conclusion:Improving the accuracy of arthroscopy and surgical techniques is the key to decrease the knee re-arthroscopy rate.