误诊为半月板损伤的膝关节紊乱的关节镜诊断和治疗
陈光;张羽飞;
摘要(Abstract):
[目的]探讨临床半月板损伤的鉴别,提高膝关节紊乱的临床诊断水平。[方法]2004年以来对62例经临床检查和MR检查诊断为半月板损伤的患者经关节镜检查确诊为非半月板损伤的膝关节紊乱。男35例,女27例,年龄16~59岁。髌内侧滑膜皱襞综合征15例,Hoff's病8例,滑膜软骨瘤病11例,滑膜瘤6例,髌骨半脱位7例,剥脱性骨软骨炎6例,色素沉着绒毛结节性滑膜炎7例,滑膜血管病2例。全部病例均在关节镜下确诊后,一期行镜下手术治疗。[结果]62例术前诊断为半月板损伤的患者经关节镜检查确诊为非半月板损伤的膝关节紊乱,随诊11~27个月,术后较术前临床症状明显改善。疗效评定:优30例(49%),良23例(37%),可9例(14%)。[结论]膝关节内很多疾患尽管病因不同,但在临床症状、体征方面有许多相似之处,只有通过临床仔细的鉴别诊断,才能提高诊断的准确率,不能单纯依据MR进行诊断,关节镜检查是确诊的重要手段。
关键词(KeyWords): 半月板损伤;误诊;膝关节紊乱;关节镜
基金项目(Foundation):
作者(Author): 陈光;张羽飞;
Email:
DOI:
参考文献(References):
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