半月板部分切除和非手术治疗膝内侧半月板退行性损伤的对比研究  

Comparison of clinical efficacy of partial meniscectomy and non-operative treatment for degenerative medial meniscal tears

作　　者：梁钰 李强[1] 郭艾[1] 刘爱华[2] 李云鹏[2] 马立峰[1] LIANG Yu;LI Qiang;GUO Ai(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Orthopaedics,Beijing Pinggu Hospital,Beijing 101200,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050 [2]北京市平谷区医院骨科,北京101200

出　　处：《临床和实验医学杂志》2020年第2期205-209,共5页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(编号:31171672)

摘　　要：目的比较关节镜下半月板部分切除和系统非手术治疗退行性膝关节内侧半月板损伤的临床疗效。方法采用前瞻性研究方法,选取2016年8月至2017年6月首都医科大学附属北京友谊医院骨科收治的退行性膝关节内侧半月板损伤患者62例,所有患者均接受膝关节磁共振检查证实为退行性膝关节内侧半月板损伤。按照单纯随机抽样法将患者分为手术治疗组和非手术治疗组,每组各31例。手术治疗组患者接受关节镜下膝关节内侧半月板部分切除,非手术治疗组患者采用口服非甾体抗生素、冲击波和运动疗法治疗。治疗前和治疗后6个月分别使用膝关节损伤和骨关节炎结果评分(KOOS评分)、Tegner活动度评定量表(Tegner评分)和Lysholm膝关节评分(Lysholm评分)评价膝关节功能和疼痛程度,并且比较两种方法的治疗效果。结果截止到2018年1月,除3例患者失访外,59例患者获得完整门诊随访,其中手术治疗组30例,非手术治疗组29例。手术组治疗前KOOS评分、Tegner活动度评定量表评分和Lysholm膝关节评分分别为(308.8±11.2)分,(3.3±1.2)分和(65.2±9.6)分;而非手术治疗组治疗前上述指标分别为(306.7±10.3)分,(3.4±1.3)分和(64.8±8.1)分;两组各评分比较差异无统计学意义(P>0.05)。治疗6个月后,手术组患者KOOS评分、Tegner活动度评定量表评分和Lysholm膝关节评分分别为(310.6±10.8)分、(3.5±1.3)分、(65.2±9.6)分,非手术治疗组上述指标分别为(359.1±18.4)分、(4.6±1.7)分、(73.2±10.1)分,非手术组各评分均明显优于手术组,差异有统计学意义(P<0.05)。非手术组优良率(72.4%)明显高于手术组(46.7%),差异具有统计学意义(P<0.05)。结论对于退行性膝关节内侧半月板损伤,系统非手术治疗的效果优于关节镜下半月板部分切除的临床疗效,所以首选推荐使用系统的非手术治疗方法。Objective To compare the clinical efficacy of partial meniscectomy and systematic non-operative treatment for degenerative medial meniscal tear.Methods A prospective study enrolled sixty-two patients who were diagnosed degenerative medial meniscal tear in the Department of orthopaedics,Beijing Friendship Hospital,Capital Medical University from August 2016 to June 2017 was conducted.All patients underwent magnetic resonance imaging to confirm the diagnosis of degenerative medial meniscal tear.The patients were randomly divided into operation group and non-operation group,with 31 cases in each group.The patients in operation group received arthroscopic partial meniscectomy,while the patients in non-operation group were treated with non-steroidal anti-inflammatory drugs,radial extracorporeal shockwave therapy and exercise therapy.Knee Injury and Osteoarthritis Outcome Score(KOOS),Tegner Activity Scale and Lysholm Knee Scoring Scale were recorded before treatment and 6 months after treatment to evaluate the function of knee and the pain scale in order to compare the therapy outcome between two groups.Results Until January 2018,except for three patients lost to follow-up,fifty-nine patients including 30 patients in operation group and 29 patients in non-operation group were followed-up.Before treatment,KOOS,Tegner Activity Scale and Lysholm Knee Scoring Scale in operation group were 308.8±11.2,3.3±1.2 and 65.2±9.6 respectively.While in non-operation group,they were 306.7±10.3,3.4±1.3 and 64.8±8.1 respectively.There was no significant difference in each score between the two groups(P>0.05).After 6 months of the treatment,KOOS score,Tegner activity scale score and Lysholm knee joint score in operation group were 310.6±10.8,3.5±1.3 and 65.2±9.6 respectively.While in non-operation group they were 359.1±18.4,4.6±1.7,73.2±10.1 respectively,significantly better than those in operation group(P<0.05).The excellent rate of non-operation group(72.4%)was higher than that of operation group(46.7%),and the difference w

关 键 词：膝内侧半月板退行性损伤 关节镜 半月板切除 非手术治疗 功能恢复 随访研究 

分 类 号：R687.4[医药卫生—骨科学]