关节镜下治疗伴有半月板撕裂、游离体的膝关节骨关节炎的临床疗效分析  

Efficacy of arthroscopic treatment for knee osteoarthritis combined with meniscus tear and(or) joint loose bodies

作　　者：鲁经纬 徐志宏[1] 陈东阳[1] 史冬泉[1] 蒋青[1] 

机构地区：[1]南京大学医学院附属鼓楼医院关节疾病诊治中心,南京210008

出　　处：《中国骨与关节外科》2015年第2期112-115,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家杰出青年科学基金(81125013);国家临床医学中心&江苏省临床医学中心&南京市临床医学中心

摘　　要：背景：关节镜手术已广泛应用于膝关节骨关节炎的治疗，然而，AAOS在其最新发布的膝关节骨关节炎临床指南中强烈不推荐对首诊为单纯症状性骨关节炎的病例行关节镜冲洗和（或）清理。目的：探讨关节镜下治疗不同症状的膝关节骨关节炎的临床疗效。方法：选择2011年1月至2013年12月首诊为膝关节骨关节炎的病例。回顾手术录像，记录半月板成形、髁间窝成形、滑膜部分切除、游离体摘除、钻孔减压、软骨成形、外侧支持带松解等手术操作。按照症状改善情况进行分类随访，对患者的主观满意度及HSS评分进行术前与术后比较，对主要症状（疼痛、交锁、屈伸受限、肿胀）的改善情况进行统计。结果：共121例患者获得完整随访信息，术后随访时间7～44个月，平均随访24个月，Kellgren．LawrenceX线分级：0级6例、Ⅰ级68例、Ⅱ级45例、Ⅲ级2例。102例（84．0％）患者得到了满意的治疗效果。平均膝关节HHS评分由术前的（45．5±4．9）分提高到术后（75．6±15．1）分（P〈0．05），因半月板撕裂、游离体出现引起的交锁及屈伸受限等症状在术后有较高的改善率（分别为95．2％和8I．1％）。结论：对于伴有由半月板撕裂、游离体导致的交锁及屈伸活动受限的骨关节炎病例，关节镜手术治疗效果明确；对于无其他合并病变的单纯骨关节炎，关节镜疗效不确切。Background： Patients with gouty arthritis are common in practice and may be not controlled well only with drugs. Arthroscopic treatment may be helpful in those cases, while the effectiveness should be evaluated. Objective： To evaluate the effectiveness of the arthroscopic treatment in gouty arthritis Methods： The gouty arthritis patients who underwent arthroscopic surgery in Peking Union Medical College Hospital from January 2000 to December 2012 were retrospectively reviewed. Blood uric acid level, erythrocyte sedimentation rate （ESR）, C reactive protein （CRP） were collected at the time ofpre-operation, 1 week and 6 months of post-operation. The visual analogue scale （VAS） and Lysholm＇s function scoring were also evaluated. Results： A total of 19 patients （26 knees） were confirmed with the diagnosis of gouty arthritis under arthroscopy. Statistic analysis showed that the VAS and Lysholm function scores were significant better at 1 week after the operation than those of pre-operation （P〈0.01）. No complication occurred. After 6 months follow-up, the level of blood uric acid and inflammatory factors （ESR and CRP） were significantly decreased, and the VAS and Lysholm scores remained improved as well. Only 2 cases had recurrent symptom due to poor diet control and relieved by drugs. Conclusions： Knee arthroscopic debridment can help to relieve the pain in gouty arthritis patients. It has short-term effectiveness as well.

关 键 词：骨关节炎 关节镜 膝关节 

分 类 号：R687[医药卫生—骨科学]