关节镜下360°去神经化治疗膝关节骨关节炎85例  

Arthroscopic 360° denervation for knee osteoarthritis： a report of 85 cases

作　　者：顾海峰[1] 毕擎[1] 孟可馨[1] 曹力[1] 赵晨[1] 章水均[1] 

机构地区：[1]浙江省人民医院骨科,杭州310014

出　　处：《中华创伤杂志》2014年第6期555-559,共5页Chinese Journal of Trauma

摘　　要：目的比较关节镜下360°去神经化与膝关节常规清理术治疗膝关节骨关节炎的疗效。方法收集2006年5月-2011年5月共90例骨关节炎患者，5例患者失随访，最终纳入85例，按入院尾数单双号分为两组，A组42例接受关节镜下关节清理术，B组43例接受关节镜下关节清理加360。去神经化，其中创伤性关节炎30例，退行性关节炎55例；男34例，女51例；平均年龄63岁（52—73岁）。比较两组患者术前、术后西安大略和麦克马斯特大学骨关节炎指数评分（Western Ontario and McMaster University Osteoarthritis Index，WOMAC）、健康调查简表（the MOS item short from health survey，SF-36）及视觉模拟评分（visual analogue scale，VAS）。结果术后两组WOMAC评分、SF-36评分较术前均有改善，B组术后6，12，24个月WOMAC评分的平均值分别为81．0，78．5，82．4，低于A组的86．8，83．8，91．7；B组术后6，12，24个月SF-36评分的平均值分别为47．4，46．3，44．4，高于A组的43．9，41．4，39．5（P〈0．05）。B组术后1周的VAS评分1．6低于A组的2．6（P〈0．05）。两组术后关节肿胀的发生差异无统计学意义（P〉0．05）。结论根据膝关节骨关节炎的受累范围、膝关节腔内滑膜神经分布的特点，360°去神经化可以进行全方位多间室的彻底清理，并尽可能多地去除膝关节腔内滑膜的神经支配，在术后症状改善情况及维持时间上均较常规清理术疗效显著。Objective To compare the curative effect of 360°arthroscopic denervation and routine arthroscopie debridement in treatment of knee osteoarthritis. Methods A total of 85 patients were included in the study after excluding the 5 follow-up dropout among the 90 patients with knee osteoarthritis treated between May 2006 and May 2011. Subsequently, the odd and even quality of the mantissa of admission number was used to determine the groups： Group A, 42 patients underwent routine arthroscopic debridement; Group B, 43 patients underwent arthroscopic debridement plus 360 degree denervation. Traumatic and degenerative arthritis occurred in 30 and 55 patients respectively. There were 34 male and 51 female patients whose mean age was 63 years （range, 52-73 years）. Western Ontario and McMaster University Osteoarthritis Index （WOMAC） , MOS item short from health survey （SF-36）, and visual analogue score （VAS） were compared between the two groups before and after operation. Results WOMAC score and SF-36 score of the two groups improved after surgery. At postoperative 6 months, 12 months, and 24 months, WOMAC in Group B scored 81.0, 78.5, and 82.4 respectively, lower than 86. 8, 83.8, and 91.7 in Group A （P 〈0.05） ; SF-36 in group B scored 47.4, 46.3, and 44.4 respectively, higher than 43.9, 41.4, and 39.5 in group A （P 〈 0.05）. At postoperative 1 week, VAS of group B was 1.6 points, lower than 2.6 points in group A （ P 〈 0.05 ）. There was no statistical difference between the two groups in postoperative swelling of joint （P 〉 0. 05 ）. Conclusions According to the area involved in knee osteoarthritis and characteristics of innervation of knee joint synovium, arthroscopic 360° denervation provides thorough debridement and removes as many innervation of knee joint synovium. Arthroseopic 360° denervation is superior to the routine arthroscopic debridement in improvement and duration of the symptoms.

关 键 词：膝关节 关节炎 关节镜 

分 类 号：R687.4[医药卫生—骨科学]