关节镜下退行性膝骨关节炎合并前交叉韧带撞击症的诊治

Diagnosis and treatment of degenerative knee osteoarthritis combined with anterior cruciate ligament impingement

目的探讨关节镜下退行性膝骨关节炎(KOA)合并前交叉韧带撞击症的诊治方法。方法选取有骨性关节炎前交叉韧带撞击症的患者36例,男20例(20膝),女16例(16膝),13例患者髁间窝骨赘,9例患者胫骨髁间嵴形成骨赘,9例患者髁间窝滑膜增生肥厚,5例患者膝关节含游离体。对其症状、体征、关节镜下的表现进行总结分析,行股骨髁间窝扩大成形及关节清理术。结果 36例病例随访6~12个月,患者术后病情明显好转,膝关节功能改善。患者术前Lysholm评分平均57分(40~76分),术后1个月平均69分(67~72分),平均增加12分;术后3个月平均74分(65~77分),平均增加17分;术后6个月平均86分(71~96分),平均增加29分,与术前比较差异均有统计学意义(P<0.05)。结论 KOA患者不仅要在关节镜下清除关节内碎裂的退变软骨和增生的骨赘,去除游离体,修整半月板,同时也要注意前交叉韧带的撞击情况,去除撞击因素,改善患者预后。

Objective To investigate the diagnosis and treatment of degenerative knee ostcoarthritis （KOA） combined with anterior cruciate ligament impingement. Methods Selection of osteoarthritis of anterior cruciate ligament impingement syndrome in 36 patients, 20 male （20 knees） and 16 female （16 knees）, 13 cases of intercondylar fossa osteophytes, 9 cases of tibial intercondylar eminence osteophytes, 9 cases of intercondylar fossa synovial hypertrophy, free body of knee joint in 5 cases. The symptoms, signs and arthroscopic manifestations were analyzed, and the expanded shape and joint de- bridement of the femoral condyle fossa were performed. Results Thirty-six cases were followed up for 12 to 6 months, the patient＇ s condition was obviously improved, and the knee joint function was improved. Patients with preoperative Lysholm score was 57 points （40 -76 points）, after 1 month with an average of 69 points （67 -72 points）, the average increase of 12 points; Three months after operation with an average of 74 points （65 -77 points）, the average increase of 17 points; Six months after operation （average 86 points, 71 -96 points） , the average increase of 29 points, compared with preopera- tive, the differences were statistically significant （ P 〈 0. 05 ）. Conclusion KOA patients not only to remove articular oste- ophytes and broken in arthroscopic degenerative cartilage and hyperplasia, removal of loose bodies, dressing and meniscus, also want to pay attention to the impact of the anterior cruciate ligament, remove the impact factors to improve the prognosis of patients.