630例膝关节镜手术并发症分析及防治对策

The complications analysis and management in 630 knee arthroscopic surgeries

摘要:

目的 分析膝关节镜手术意外及并发症发生的原因并提出防治对策。方法 2001年～2011年该院行关节镜手术630例。其中骨性关节炎关节清理术371例，创伤性关节炎及各种滑膜病变行滑膜切除术92例，半月板损伤成形术64例，交叉韧带重建术36例，游离体取出术36例，关节粘连松解术25例，髁间嵴撕脱骨折6例。 结果 平均随访10.2月（6～18）月，发生的各种意外及并发症20例。术中关节内组织结构损伤6例，关节周围重要血管神经损伤2例，器械断裂2例。术后关节内血肿7例，下肢深静脉血栓2例，膝关节粘连1例。对术中及术后主要并发症进行统计分析，并提出防治对策。 结论 膝关节镜手术并发症与关节镜操作技术欠佳、解剖及关节内结构显露不清和手术复杂程度等因素有关，技术改进并及时处理并发症，才能提高膝关节镜手术的临床疗效，降低严重并发症的发生。

Abstract:

【Objective】 To analyze the cause of the accidents and complications in the knee arthroscopic surgeries. 【Methods】 The study was carried out on 630 cases of knee arthroscopy during 2001 to 2011, including 371 cases of arthroscopic debridement for osteoarthritis, 92 cases of synovectomy for traumatic arthritis and synovitis, 64 cases of meniscus reconstruction, 36 cases of cruciate ligaments reconstruction, 36 cases of knee corpus liberum dislodgment, 25 cases of lysis of adhesions of joint, and 6 cases of avulsion fractures of cruciate ligament from the tibial. 【Results】 The patients were followed up for an average time of 10.2 months (6 to 18 months). There were totally 20 relatively severe accidents and complications. Normal tissues injury in 6 cases, nerve branch and vascular injury in 2 cases, surgical instruments broken in the articular cavity took place in 2 cases, postop intraarticular hematoma in 7 cases, lower limb deep venous thrombosis in 2 cases, synarthrophysis in 1 case. 【Conclusion】 Complications during the knee arthroscopy are mainly related to unskillful using of the instruments, lack of anatomy knowledge, inadequate exposure and operation multiplicity of the intraarticular structure. The prevention of the points above can decrease the complication ratio and the treatment of the complications in time may avoid severe results.