本文選題：膝關(guān)節(jié) + 半月板　； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：背景:骨髓水腫綜合癥(bone marrow edema syndrome,BMES)是一種特殊但診斷不足,好發(fā)于下肢的一類疼痛癥狀,病因及發(fā)病機制仍具爭議,缺乏治療金標(biāo)準(zhǔn)。因其病程可逆性,以往保守治療在一定程度上可以緩解疼痛,改善癥狀,逆轉(zhuǎn)病程,但治療周期長且部分病例效果不理想。半月板損傷合并膝關(guān)節(jié)骨髓水腫好發(fā)于老年患者,常為內(nèi)側(cè)半月板損傷伴脛骨平臺或股骨內(nèi)髁的水腫,機理不明,可能與半月板損傷后機械應(yīng)力異常引起B(yǎng)ME有關(guān)。本文探討關(guān)節(jié)鏡下行半月板修整及同時經(jīng)皮減壓治療半月板損傷合并膝關(guān)節(jié)周圍BMES的效果。方法:選取南昌大學(xué)第四附屬醫(yī)院在2010年1月-2014年12月期間,收治的22例半月板損傷合并膝關(guān)節(jié)BMES患者,并由同一主刀醫(yī)生給他們?nèi)啃嘘P(guān)節(jié)鏡下半月板修整及經(jīng)皮鉆孔減壓治療術(shù),同時全部術(shù)后隨訪至24個月,分別比較術(shù)前和術(shù)后的疼痛視覺模擬評分(VAS)、Lysholm評分、磁共振影像表現(xiàn)和患者滿意度。結(jié)果:術(shù)后1、3、6、12、24月隨訪:VAS均值均較術(shù)前有明顯降低,差異具有統(tǒng)計學(xué)意義,術(shù)后1個月患者疼痛癥狀明顯緩解,只有6例患者有感疼痛,疼痛難忍,影響食欲及睡眠,但尚能忍受;術(shù)后3個月及以后VAS評分均為6分以下,極少部分患者感疼痛并影響睡眠,但尚能忍受。術(shù)后半年至一年效果最好,術(shù)后2年部分患者VAS評分稍有增加;Lysholm均值均較術(shù)前有明顯提高,差異具有統(tǒng)計學(xué)意義,術(shù)前有20例患者膝關(guān)節(jié)功能嚴(yán)重障礙,術(shù)后膝關(guān)節(jié)功能有明顯改善,術(shù)后半年至一年膝關(guān)節(jié)功能改善效果最好,術(shù)后2年部分患者Lysholm評分稍有降低;術(shù)后6個月;磁共振上骨髓水腫征象完全消失,原水腫部位無明顯疼痛,影像學(xué)與臨床體征結(jié)果一致;末次隨訪時,18例患者對手術(shù)效果感到滿意,患者滿意度為82%。結(jié)論:對半月板損傷合并膝關(guān)節(jié)周圍BMES的患者行關(guān)節(jié)鏡下半月板修整及經(jīng)皮減壓術(shù)可有效的緩解疼痛癥狀、改善膝關(guān)節(jié)功能及骨髓內(nèi)血運,可以作為臨床上治療半月板損傷合并膝關(guān)節(jié)周圍BMES的一種有效治療方案。
[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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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