| 膝半月板损伤临床自然转归的研究 |
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Received:July 10, 2013
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| 作者 | Author | 单位 | Unit | E-Mail |
| 徐洪海 |
XU Hong-hai |
西安交通大学医学院第三附属医院 陕西省人民医院骨一科, 陕西 西安 710068 |
The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710068, Shaanxi, China |
xuhonghai1963@126.com |
| 张峰 |
ZHANG Feng |
西安交通大学医学院, 陕西 西安 710061 |
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| 刘宁 |
LIU Ning |
西安交通大学医学院, 陕西 西安 710061 |
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| 郑晶晶 |
ZHENG Jing-jing |
西安交通大学医学院, 陕西 西安 710061 |
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| 张银萍 |
ZHANG Yin-ping |
西安交通大学医学院, 陕西 西安 710061 |
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| 赵全民 |
ZHAO Quan-min |
西安交通大学医学院, 陕西 西安 710061 |
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| 郭雄 |
GUO Xiong |
西安交通大学医学院, 陕西 西安 710061 |
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| 于敏 |
YU Min |
西安交通大学医学院, 陕西 西安 710061 |
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| 刘宗智 |
LIU Zong-zhi |
西安交通大学医学院第三附属医院 陕西省人民医院骨一科, 陕西 西安 710068 |
The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710068, Shaanxi, China |
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| 孙正明 |
SUN Zheng-ming |
西安交通大学医学院第三附属医院 陕西省人民医院骨一科, 陕西 西安 710068 |
The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710068, Shaanxi, China |
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| 邹庆洋 |
ZOU Qing-yang |
西安交通大学医学院第三附属医院 陕西省人民医院骨一科, 陕西 西安 710068 |
The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710068, Shaanxi, China |
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| 刘琮 |
LIU Cong |
西安交通大学医学院第三附属医院 陕西省人民医院骨一科, 陕西 西安 710068 |
The Third Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710068, Shaanxi, China |
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| 期刊信息：《中国骨伤》2013年26卷，第10期，第836-840页 |
| DOI：10.3969/j.issn.1003-0034.2013.10.011 |
| 基金项目:陕西省科学技术研究发展计划项目(编号:2011K14-08-02);西安市科技计划项目[编号:HM1121(1)];陕西省科技计划项目(编号:2001K10-G9) |
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目的: 探讨损伤半月板无治疗情况下临床及创缘的变化,为临床治疗提供理论依据.
方法: 自2001年1月至2011年12月选择膝关节外伤而未诊治过的初诊68例患者,经临床表现(疼痛、交锁、不稳等)及膝关节MRI检查诊断为半月板损伤的患者行关节镜检查,其中32例半月板无法修复行全切术,男21例,女11例,年龄15～49岁,平均25岁,损伤至关节镜检查平均时间46周. 观测指标:①膝关节术前术后Lysholm评分. ②关节镜下半月板的损伤部位、类型和状态. ③组织学观察:切取半月板损伤创缘不同部位的组织,一部分甲醛固定、石蜡包埋切片、HE染色、光镜观察;另一部分3%戊二醛固定、环氧树脂包埋、柠檬酸铅染色、电镜观察.
结果: 32例均获随访,时间1年以上. 术后3个月与术前Lysholm评分比较差异有统计学意义(t=15.6,P<0.01).关节镜下可见典型表现28例:创缘中部与两端有新旧之别;非典型表现4例. 光镜下可见典型表现26例:创缘中部少量类上皮细胞,两端交界部有较为明显的组织愈合细胞(成纤维细胞等);非典型表现2例. 电镜下可见典型表现25例:伤缘中部偶见细胞(同源及类上皮)胞核胞浆呈萎缩状态,伤缘两端交界部成纤维细胞体积增大、突起较多、胞核较大,胞浆内含较多粗面内质网、游离核糖体和高尔基复合体,软骨细胞呈圆形或卵圆形,核大而圆,胞浆内较多的粗面内质网和游离核糖体,软骨细胞周围有软骨陷窝;非典型表现3例.
结论: 半月板损伤后未治疗或愈合之前负重活动,将导致创面长度增大,临床症状加重,提示半月板损伤后早期诊断治疗,及时有效制动是半月板痊愈、避免后期手术切除的关键. 无法修复的半月板全切后近期临床效果满意. |
| [关键词]:膝关节 半月板 关节镜检查 创伤和损伤 组织学技术 |
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| Clinical natural development in human meniscus injury |
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Abstract:
Objective: To investigate the changes of clinic and wound edge of the meniscus without treatment in order to provide a theoretical basis for clinical treatment.
Methods: From January 2001 to December 2011,68 patients with knee injury without diagnosis and treatment were selected in the study. According to clinical symptoms (pain,interlocking,instability,etc.) and knee MRI,32 patients were diagnosed as meniscus injury and underwent the arthroscopy. Total meniscectomy was performed in 32 cases on account of impossible repair of the meniscus. There were 21 males and 11 females,ranging in age from 15 to 49 years old with an average age of 25 years old,with an average time from diagnosis to arthroscopy for 46 weeks. Observation indexes included ①Preoperative and postoperative Lysholm scores of knee.②Position,type and status of injury by arthroscopy.③Observation of histology. With the procedure as follow:tissue samples were taken from different positions of the edge of the meniscus wound,and were divided into two parts. One part of sample was fixed with formalin,sliced with paraffin imbedding,and observed under an electron microscope after HE staining,and the other part of the sample was fixed with glutaraldehyde of 3%,sliced with ethoxyline imbedding,and observed under an electron microscope after Lead Citrate staining.
Results: Thirty-two patients were followed up more than one year. There was significant differences in Lysholm scores bewteen preoperative and postoperative 3 months(t=15.6,P<0.01). Arthroscopy showed typical differences in 28 cases between the middle and the two ends of the wound edge and atypical differences in 4 cases. Light microscope showed typical manifestations in 26 cases,a few epithelioid cells could been seen fat the middle of the wound edge as well as cells tissue healing (such as fibroblasts) at the junction of each end,and atypical manifestations in 2 cases. Electron microscope showed typical manifestations in 25 cases and atypical manifestations in 3 cases. Typical manifestations in electron microscope showed the atrophic state of nuclei and kytoplasm of cell (isogenous cells and epithelioid cells) at the middle of the wound edge;at the either junction of the wound edge,the fibroblasts exhibited an enlarged volume with many protuberances;the nuclei also increased in size,and the cytoplasm contained major rough endoplasmic reticulum,free ribosomes and Golgi complex;chondrocytes were round or oval with a large,round nucleus;a large amount of rough endoplasmic reticulum and many free ribosomes could be observed in the cytoplasm;cartilage lacunae were observed surrounding chondrocytes.
Conclusion: Weight loading activities with meniscus injury without treatment or before healing will increase the length of the wound and aggravate clinical symptoms. These findings indicate that early diagnosis and treatment combined with timely and effective immobilization is a key to the healing of meniscus injury and avoiding further surgery. The recent clinical effect of total meniscectomy is satisfacory in treating impossible repair meniscus. |
| KEYWORDS:Knee joint Meniscus Arthroscopy Wounds and injuries Histological techniques |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐洪海,张峰,刘宁,郑晶晶,张银萍,赵全民,郭雄,于敏,刘宗智,孙正明,邹庆洋,刘琮.膝半月板损伤临床自然转归的研究[J].中国骨伤,2013,26(10):836~840 |
| 英文格式: | XU Hong-hai,ZHANG Feng,LIU Ning,ZHENG Jing-jing,ZHANG Yin-ping,ZHAO Quan-min,GUO Xiong,YU Min,LIU Zong-zhi,SUN Zheng-ming,ZOU Qing-yang,LIU Cong.Clinical natural development in human meniscus injury[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(10):836~840 |
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