摘要
目的探讨保守治疗无效的中、重度膝关节骨关节炎（KOA）的关节镜微创治疗效果和关节镜微创手术的适应证。方法1995年8月至2002年8月对进行关节镜微创手术治疗时年龄〉40岁、于术已超过4年的64例中、重度KOA患者资料进行回顾性研究。手术时患者平均年龄为（52．6±8．2）岁；男21例，女43例；左膝35例，右膝29例。记录所有患者术前、末次随访时的阳性和阴性体征、术中软骨损伤和伴随手术情况，以及膝关节临床评分系统（KSS）评分。综合分析患者年龄、接受治疗情况、术前x线片改变、末次随访时膝关节功能恢复情况及关节镜微创于术治疗的效果，对KOA关节镜手术的适应证进行分析。结果64例患者术后获平均（5．3±1．3）年随访，关节镜手术中有52例进行了半月板损伤的部分切除或全切除术，20例进行了关节鼠取出术，2例进行了前交叉切带重建术。住软骨损伤中，股骨滑车区发生率最高，其次是髌骨，再次是股骨内髁负重区。末次随访时患者膝关节的阳性体征从术前的363个减少为214个（x2=60．121，P=0．000）。64例患者未次随访时膝关节评分、功能评分和KSS总分分别为（41．12±4．17）、（69．69±5．17）、（110．80±7．77）分，与术前比较差异均有统计学意义（P〈0．05）：根据KSS评分评估临床效果：优34例，良20例，可6例，差4例，优良率为84．4％。10例疗效为可和差的患者术后1年内有8例接受了全膝关节置换手术。结论严格掌握合适的手术适应证，合理应用关节镜技术治疗中 、重度KOA可以获得比较满意的疗效。但要防止关节镜手术治疗KOA的扩大化，以避免患者接受关节镜手术无效后在短时间内再进行关节置换手术。
Objective To discuss the clinical indications and effects of minimally invasive arthroscopy for 40-plus-year-old patients with moderate to severe knee osteoarthritis （KOA）. Methods A retrospective study was conducted to include a total of 64 patients （21 males and 43 females） with moderate to severe KOA who had been operated on from August 1995 to August 2002. Their average age was 52.6 ± 8.2 years old. Their positive and negative physical signs before and after surgery and articular cartilage injuries as well were recorded. The knee society clinical rating system （KSS） scores before operation and at the last follow-up were recto＇tied for every patient. Indications for KOA arthroscopy were based on a comprehensive analysis of age, previous therapies, X-ray changes, knee function, and possible clinical effects of arthroseopy for the patient. Results They were followed up for an average of 5.3 ± 1. 3 years. Of the 64 eases, 52 needed Iotal or partial meniscectomy, 20 removal of loose bodies, and 2 anterior cruciate ligament reconstruction. The cartilage injury occurred mostly and the most seriously in the trochlea, next in the patella and then in the medial compartments. The positive physical signs decreased from 363 times before arthroscopy to 214 at the last follow up （X2 =60. 121, P =0. 000） . The knee score, funetion score and total KSS score improved very significantly （ P 〈 0.05）. The excellent to good rate was 84.4%. Of the 10 poor cases, 8 accepted total knee arthroplasty within one year after arthroscopy. Conclusions Satisfactory elinieal results can be achieved for moderate and severe KOA by minimally invasive arthroscopy if its indications are well followed and techniques are properly used during operation. But excessive use of arthroscopy for KOA should be avoided because unreasonable arthroscopy may cause a severe KOA patient to sustain total knee arthroplasty soon.
出处
《中华创伤骨科杂志》
CAS
CSCD
2010年第4期319-323,共5页
Chinese Journal of Orthopaedic Trauma
