关节镜下半月板部分切除术联合医用几丁糖治疗退变性半月板损伤临床疗效分析  

Arthroscopic partial meniscectomy combined with chitosan injection for degenerative meniscus tear

作　　者：缪佳庆 刘岑涛 王华[1] 王先辉 陈舰 MIAO Jia-qing;LIU Cen-tao;WANG Hua;WANG Xian-hui;CHEN Jian(Dept.of Orthopedics,Putuo District People's Hospital,School of Medicine,Tongji University,Shanghai 200060,China)

机构地区：[1]同济大学附属普陀人民医院骨科,上海200060

出　　处：《同济大学学报（医学版）》2021年第5期652-657,共6页Journal of Tongji University(Medical Science)

基　　金：上海市普陀区临床特色专病能力提升项目(2020tszb04)。

摘　　要：目的探讨关节镜下半月板部分切除术联合术中注射医用几丁糖治疗退变性半月板损伤的临床疗效。方法选取2016年1月—2019年7月诊断为退变性半月板损伤行关节镜下半月板部分切除的55例患者进行回顾性分析。将患者分为关节镜下半月板部分切除术联合关节腔内注射医用几丁糖组(A组)与单纯行关节镜下半月板部分切除术组(B组),采用术前与术后的视觉模拟量表(visual analogue scale,VAS)疼痛评分及Lysholm膝关节评分评估临床疗效,通过膝关节正侧位X线检查评估膝关节炎情况及KL(Kellgren-Lawrence)分级,对两组治疗效果进行对比分析。结果两组患者的VAS疼痛评分术后较术前均有明显的降低,A组由术前的(6.10±1.54)分降到术后的(1.69±1.14)分(P<0.001),B组由术前的(5.85±1.71)分降到术后的(1.88±1.37)分(P<0.001)。两组Lysholm膝关节评分有明显提升,A组由术前的(57.34±13.08)分提升到术后的(86.55±9.95)分(P<0.001);B组由术前的(58.85±10.79)分提升到术后的(84.12±11.44)分(P<0.001)。末次随访A组患者满意率89.66%,B组患者满意率80.77%。A组患者术后3个月VAS疼痛评分较B组降低(P=0.007),B组有4例患者末次随访KL分级进展(P=0.044)。结论关节镜下半月板部分切除术治疗退变性半月板损伤具有较好的临床疗效,同时联用医用几丁糖能减轻患者术后短期痛苦,减缓膝关节炎进展。Objective To evaluate the clinical efficacy of arthroscopic partial meniscectomy combined with intraoperative injection of chitosan in the treatment of degenerative meniscus tear.Methods Fifty-five patients diagnosed with degenerative meniscus tear who underwent partial meniscectomy between January 2016 and July 2019 were included.Of the 55 patients,29 received arthroscopic partial meniscectomy combined with intra-articular injection of medical chitosan(group A)and 26 received arthroscopic partial meniscectomy only(group B).Preoperative and postoperative assessments were compared by visual analogue scale(VAS)pain score,Lysholm knee score and Kellgren-Lawrence(KL)grade.Results Both groups had significantly reduced VAS pain scores(group A:6.10±1.54 preoperatively to 1.69±1.137 postoperatively,P<0.001;group B:5.85±1.713 preoperatively to 1.88±1.366 postoperatively,P<0.001)and improved Lysholm knee scores(group A:57.34±13.08 preoperatively to 86.55±9.95 postoperatively,P<0.001;group B:58.85±10.79 preoperatively to 84.12±11.44 postoperatively,P<0.001).At the last follow-up,the satisfaction rate of group A was 89.66%,and that of group B was 80.77%.The VAS pain score of group A was lower than that of group B(P=0.007)at 3 months after operation,and there were 4 patients with KL grade progress in group B at the last follow-up(P=0.044).Conclusion Arthroscopic partial menis-cectomy obtains a good clinical result in the treatment of degenerative meniscus tear.When combined with medical chitosan injection,it can relieve the short-term pain of patients and slow down the progress of knee osteoarthritis.

关 键 词：退变性半月板损伤 关节镜下半月板部分切除 医用几丁糖 膝关节炎 

分 类 号：R684[医药卫生—骨科学]