摘要
目的探讨关节镜下异体半月板移植的手术适应证、康复训练计划和免疫反应等问题。方法建立国人异体半月板组织库,对12例半月板损伤后切除半月板的患者,在关节镜下实施异体半月板移植微创手术,制定康复计划,观查其临床效果,结合文献讨论异体半月板移植术的围手术期相关问题。结果本组患者均无手术副损伤,早期关节轻度肿胀,无伤口渗液。术后2周,伤口愈合良好。术后6周,关节肿胀基本消失。随访6～17个月(平均10.3个月),患者行走功能正常,膝关节活动度均值与术前比较差异无统计学意义。膝关节疼痛评分(VAS)术后明显低于术前(P<0.01)。Lysholm评分术后明显提高(P<0.05)。术后各项免疫学指标均在正常范围。MRI示移植半月板位置良好,固定可靠。1例患者术后12周关节镜检查,见移植半月板形态正常,与关节囊愈合良好。结论鉴于目前对半月板切除术后(半月板缺损)的并发症治疗存在很大困难,异体半月板移植可能成为一项重要的临床治疗技术。异体半月板移植可获得较好的近期临床效果,临床未见明显的免疫排斥反应。但有关异体半月板移植手术适应证、康复训练及远期效果等围手术期的相关问题还需更深入的探讨。
Objective To analysis and discuss the problems of peri-operation, such as surgical indications, rehabilitaion and immunoreaction of meniscal transplantation based on clinical practical results. Methods After establishing meniscus allograft bank, the meniscal allograft transplantation were performed with arthroscopic technique on 12 patients suffering from meniscus defect after meniscectomies. The clinical results about recovery of functions and immunoreaction were investigated after a period of reha- bilitations. The relative clinical problems were discussed, combining the recent literatures. Results There was not any side-injury occurring in the cases. A little swell were observed on the knees, which disappeared in 6 weeks postoperatively, without exudation. The incisions were healed well in 2 weeks after the operations. The cases were followed-up for 6-17months （average 10. 3 month）, there was no significantly different between average range of motion of the knee per-operatively and that post-operatively. The postoperative VAS was significant lower than that of preoperative （P 〈 0. 01 ）. Lysholm scale was improved significantly after surgery （ P 〈 0.05 ）. Reject reaction was not observed in all of laboratory tests. MRI showed the meniscal allografts were fixed well after the procedure with proper location in the joints. Conclusions Considering the difficulty in treatment of severe meniscus injury or defect, meniscal allograft transplantation may be expectable option in the treatment of meniscus defect. A good short-term clinical result was observed without severe reject reaction. But some clinical problems need be further solved, such as the indications, rehabilitaion and long term results.
出处
《中华关节外科杂志（电子版）》
CAS
2008年第6期19-22,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
半月板
移植
同种
关节镜
手术适应证
康复
Menisci
Transplantation, homologous
Arthroscopy
Surgical indication
Rehabilitation
