关节镜下应用FasT-Fix缝合器修复半月板损伤的中期临床疗效观察

目的探讨关节镜下Fas T-Fix系统在半月板损伤修复中的临床疗效。方法 2013年1月-2016年1月,采用Fas T-Fix系统在关节镜下对32例半月板撕裂损伤患者进行了全关节内的半月板缝合手术。随访包括患者术后关节症状及体征,Lysholm评分等。结果随访时间6~12个月(平均9.7个月),根据Barrett临床愈合标准,28例临床愈合,临床愈合率为87.5%。Lysholm评分由术前32~74分提高到术后89~93分。其中3例进行了二次关节镜探查手术,显示缝合的半月板均已愈合。结论关节镜下应用Fas T-Fix系统进行半月板损伤的缝合修复具有很好的中期临床疗效。

关节镜下“四通道清理法”治疗人工膝关节置换术后关节粘连的临床疗效

目的探讨关节镜下"四通道清理法"治疗人工膝关节置换术后关节粘连的适应证和临床疗效。方法 2014年3月-2017年3月该科采用关节镜下"四通道清理法"对13例人工膝关节置换术后关节粘连患者进行镜下清理松解手术。其中,男4例,女9例;年龄58~73岁,平均66.7岁。采用Lysholm评分对膝关节术前及术后功能进行评价,记录术前及术后膝关节屈伸度数。结果随访时间6~24个月,平均13.6个月。术前平均屈曲度数为73.7°(45~90°),术后6个月随访时平均屈曲度为115.7°(97~127°)。Lysholm评分从术前平均54.0分(31~69分),提高到术后6个月时平均66.8分(51~83分)。结论关节镜下"四通道清理法"是治疗人工膝关节置换术后关节粘连安全、有效的方法,对膝关节功能的改善疗效显著。

Effect of arthroscopic debridement combined with intra-articular sodium hyaluronate injection on the Wnt/β-catenin pathway in joint fluid of patients with knee osteoarthritis

Objective: To investigate the effect of arthroscopic debridement combined with intra-articular sodium hyaluronate injection on the Wnt/β-catenin pathway in joint fluid of patients with knee osteoarthritis. Methods: Patients undergoing arthroscopic debridement for knee osteoarthritis in the hospital between June 2014 and April 2017 were selected as the research subjects and randomly divided into the observation group who accepted arthroscopic debridement combined with intra-articular sodium hyaluronate injection and the control group who accepted arthroscopic debridement alone. The Wnt/β-catenin pathway molecules as well as downstream collagen metabolism molecules and bone metabolism molecules in the joint fluid were measured before surgery and 7 d after surgery. Results: 7 d after surgery, Wnt1, Wnt5a, Wnt7b, β-catenin, MMP1, MMP13, CTX-I, CTX-II, ADAMTS4, ADAMTS5, RANK, RANKL and TRACP5b mRNA expression in joint fluid of both groups of patients were higher than those before surgery whereas OPG and OC contents were lower than those before surgery, and Wnt1, Wnt5a, Wnt7b, β-catenin, MMP1, MMP13, CTX-I, CTX-II, ADAMTS4, ADAMTS5, RANK, RANKL and TRACP5b mRNA expression in joint fluid of observation group were significantly lower than those of control group whereas OPG and OC contents were significantly higher than those of control group. Conclusion: Arthroscopic debridement combined with intra-articular sodium hyaluronate injection can inhibit the collagen metabolism and bone metabolism disorder mediated by Wnt/β-catenin after surgery.