微创关节镜在膝关节纵向撞击军事训练伤中的应用

Application of minimally invasive arthroscopy in knee joint injuries caused by longitudinal impact of military training

目的研究微创关节镜在军人膝关节纵向撞击军事训练伤中的应用。方法回顾性分析第三军医大学大坪医院关节四肢外科2006年1月至2015年1月门诊收治的因纵向撞击军事训练导致的膝关节损伤患者538例,按照《军事训练伤诊断标准及防治原则》的判定标准对其一般情况、损伤类型、致伤科目进行统计分析。根据MRI检查结果、损伤种类及程度,笔者提出膝关节纵向撞击伤的分级诊疗策略,并根据策略筛选出需接受手术治疗的患者行关节镜手术,并对所有手术患者进行术前、术后Lysholm评分和主观评价满意度调查。结果最终行手术者76例,所有患者均随访12-35个月,Lysholm术前评分[（46.3±5.3）分]与术后评分[（83.7±3.8）分]相比,差异有统计学意义（P〈0.01）。膝关节镜切口均甲级愈合,术后没有出现神经血管损伤及感染等并发症。患者主观感受膝关节功能明显改善,71例（93.4%）患者对关节镜手术疗效满意,术后患者全部返回军事训练场参加正常训练。结论微创关节镜作为膝关节纵向撞击训练伤的一种检查和治疗手段,可以更加全面地评估膝关节损伤情况,及时修复损伤半月板及韧带重建,创伤小愈合快,患者能尽快恢复常规军事训练。

Objective To explore the application of minimally invasive arthroscopy in the knee joint injuries caused by longitudinal impact of military training.Methods A total of 538 consecutive soldier outpatients diagnosed as knee joint injuries caused by longitudinal impact of daily military training in our hospital from January 2006 to January 2015 were retrospectively analyzed.According to the Principles about Diagnosis and Treatment of Military Training Injury,the general condition,injuries types and injury subject were performed the statistical analysis.The grading diagnosis and treatment strategy of impact injuries was proposed at first time according to the MRI examination results,injury type and severity.The patients needing operative therapy were screened out for conducting the arthroscopic operation according to this strategy.All the patients receiving surgeries were evaluated by the Lysholm scoring before and after operation.The subjective evaluation satisfaction investigation was performed.Results Seventy six cases received the arthroscopic surgeries,and all the cases were followed up successfully.The duration of following-up ranged12-35 months.The Lysholm scores before operation was[46.3±5.3]which were lower than [83.7±3.8]after operation,the difference was statistically significant（P〈0.01）.The wounds healed at the first stage,and no complications of nerve and blood vessel injury,infections,etc.occurred.The patients subjectively felt that the knee joint function was significantly improved,71 cases satisfied with the arthroscopic operation effect,the satisfactory rate was 93.4%.All the cases went back to the normal training life after surgeries.Conclusion For the knee joint injuries caused by longitudinal impact of military training,the prevention is the key role.On the basis of preliminary diagnosis by the physical examination and imaging examination,the treatment should be combined with the grading diagnosis and treatment strategy.In the operation therapy,the minimally invasive arthroscopy as an examination and treatment means can more comprehensively evaluate the knee injury condition,timely repair injured meniscus and conduct the ligament reconstruction,which has small trauma and recovers rapidly,the patient can recover the routine military training as soon as possible.The arthroscopy is the first choice of treatment scheme for the patients with gradeⅢ or more injury.