摘要
目的:比较关节镜下内侧半月板成形术联合小针刀内侧副韧带深层拉花样松解术与单纯关节镜下内侧半月板成形术治疗膝骨关节炎合并内侧半月板损伤的临床疗效。方法:将符合要求的50例膝骨关节炎合并内侧半月板损伤患者随机分为2组,每组25例,分别采用关节镜下内侧半月板成形术联合小针刀内侧副韧带深层拉花样松解术(联合手术组)和单纯关节镜下内侧半月板成形术(内侧半月板成形组)治疗。分别于术前及术后3个月、6个月记录并比较2组患者的胫股角(femoral-tibial-angle,FTA)、膝部疼痛视觉模拟量表(visual analogue scale,VAS)评分和Lysholm膝关节评分。结果:①胫股角。时间因素和分组因素存在交互效应(F=13.329,P=0.021);2组患者胫股角总体比较,差异有统计学意义,即存在分组效应(F=16.331,P=0.004);治疗前后不同时间点之间2组患者胫股角的差异有统计学意义,即存在时间效应(F=16.359,P=0.031);联合手术组患者胫股角随时间呈先下降后上升趋势,但内侧半月板成形组患者胫股角不随时间发生明显变化(178.35°±1.69°,174.12°±1.24°,176.24°±1.78°,F=18.531,P=0.000;178.26°±1.91°,178.38°±2.43°,181.34°±1.51°,F=4.755,P=0.091)。术前2组患者胫股角比较,差异无统计学意义(t=21.397,P=1.787);术后3个月、6个月,联合手术组胫股角均小于内侧半月板成形组(t=8.351,P=0.010;t=9.891,P=0.023)。②膝部疼痛VAS评分。时间因素和分组因素存在交互效应(F=10.275,P=0.021);2组患者膝部疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=11.336,P=0.000);治疗前后不同时间点之间2组患者膝部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=221.190,P=0.000);2组患者膝部疼痛VAS评分均随时间呈先下降后上升趋势,但2组的变化趋势不完全一致[(6.75±2.14)分,(2.05±0.96)分,(2.66±1.24)分,F=251.378,P=0.000;(6.83±1.92)分,(2.07±1.29)分,(3.73±1.27)分,F=196.977,P=0.000]。术前2组患者膝部疼痛VAS评分比较,差异无统计学意义(t=0.952,P=0.801);术后3个月、6个月,联合手术组膝部疼痛VAS评分均低于内侧半月板成形组(t=7.399,P=0.011;t=9.257,P=0.000)。③Lysholm膝关节评分。时间因素和分组因素存在交互效应(F=9.399,P=0.016);2组患者Lysholm膝关节评分总体比较,差异有统计学意义,即存在分组效应(F=19.541,P=0.000);治疗前后不同时间点之间2组患者Lysholm膝关节评分的差异有统计学意义,即存在时间效应(F=187.320,P=0.000);2组患者Lysholm膝关节评分均随时间呈先上升后下降趋势,但2组的变化趋势不完全一致[(42.15±12.14)分,(71.50±19.22)分,(61.72±18.26)分,F=197.478,P=0.000;(42.13±10.92)分,(63.65±18.35)分,(55.43±17.08)分,F=164.597,P=0.000]。术前2组患者Lysholm膝关节评分比较,差异无统计学意义(t=1.397,P=0.423);术后3个月、6个月,联合手术组Lysholm膝关节评分均高于内侧半月板成形组(t=8.491,P=0.000;t=6.352,P=0.000)。结论:关节镜下内侧半月板成形术联合内侧副韧带深层拉花样松解术治疗膝骨关节炎合并内侧半月板损伤,能在一定程度上纠正膝关节内翻畸形,缓解膝部疼痛,改善膝关节功能,疗效优于单纯的关节镜下内侧半月板成形术。
Objective:To compare the clinical curative effects of combination therapy of arthroscopic medial meniscoplasty and deep medial collateral ligament(dMCL)pie-crusting release with small needle-knife versus monotherapy of arthroscopic medial meniscoplasty for treatment of knee osteoarthritis(KOA)and medial meniscus tears(MMTs).Methods:Fifty patients with KOA and MMTs were enrolled in the study and were randomly divided into 2 groups, 25 cases in each group, and they were treated with arthroscopic medial meniscoplasty combined with dMCL pie-crusting release with small needle-knife(combination therapy group)and arthroscopic medial meniscoplasty alone(monotherapy group)respectively.The femoral-tibial-angle(FTA),knee pain visual analogue scale(VAS)score and Lysholm knee score(LKS)were recorded and compared between the 2 groups before the surgery and at 3 and 6 months after the surgery respectively.Results:(1)There was interaction between time factor and group factor in FTA(F=13.329,P=0.021).There was statistical difference in FTA between the 2 groups in general, in other words, there was group effect(F=16.331,P=0.004).There was statistical difference in FTA between different timepoints before and after the treatment, in other words, there was time effect(F=16.359,P=0.031).The FTA presented a time-dependent trend of decreasing firstly and increasing subsequently in combination therapy group, while it was not obviously changed with time in monotherapy group(178.35±1.69,174.12±1.24,176.24±1.78 degrees, F=18.531,P=0.000;178.26±1.91,178.38±2.43,181.34±1.51 degrees, F=4.755,P=0.091).There was no statistical difference in FTA between the 2 groups before the surgery(t=21.397,P=1.787).The FTA was smaller in combination therapy group compared to monotherapy group at 3 and 6 months after the surgery(t=8.351,P=0.010;t=9.891,P=0.023).(2)There was interaction between time factor and group factor in knee pain VAS scores(F=10.275,P=0.021).There was statistical difference in knee pain VAS scores between the 2 groups in general, in other words, there was group effect(F=11.336,P=0.000).There was statistical difference in knee pain VAS scores between different timepoints before and after the treatment, in other words, there was time effect(F=221.190,P=0.000).The knee pain VAS scores presented a time-dependent trend of decreasing firstly and increasing subsequently in the 2 groups, while the 2 groups were inconsistent with each other in the variation tendency(6.75±2.14,2.05±0.96,2.66±1.24 points, F=251.378,P=0.000;6.83±1.92,2.07±1.29,3.73±1.27 points, F=196.977,P=0.000).There was no statistical difference in knee pain VAS scores between the 2 groups before the surgery(t=0.952,P=0.801).The knee pain VAS scores were lower in combination therapy group compared to monotherapy group at 3 and 6 months after the surgery(t=7.399,P=0.011;t=9.257,P=0.000).(3)There was interaction between time factor and group factor in LKSs(F=9.399,P=0.016).There was statistical difference in LKSs between the 2 groups in general, in other words, there was group effect(F=19.541,P=0.000).There was statistical difference in LKSs between different timepoints before and after the treatment, in other words, there was time effect(F=187.320,P=0.000).The LKSs presented a time-dependent trend of increasing firstly and decreasing subsequently in the 2 groups, while the 2 groups were inconsistent with each other in the variation tendency(42.15±12.14,71.50±19.22,61.72±18.26 points, F=197.478,P=0.000;42.13±10.92,63.65±18.35,55.43±17.08 points, F=164.597,P=0.000).There was no statistical difference in LKSs between the 2 groups before the surgery(t=1.397,P=0.423).The LKSs were higher in combination therapy group compared to monotherapy group at 3 and 6 months after the surgery(t=8.491,P=0.000;t=6.352,P=0.000).Conclusion:The combination therapy of arthroscopic medial meniscoplasty and arthroscopic dMCL pie-crusting release with small needle-knife can correct knee varus deformity, relieve knee pain and improve knee function to some extent in the treatment of KOA and MMTs, and its curative effect is better than that of monotherapy of arthroscopic medial meniscoplasty.
作者
刘辉
陈先进
钱辉
LIU Hui;CHEN Xianjin;QIAN Hui(Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China)
出处
《中医正骨》
2021年第11期18-23,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
安徽省中医药领军人才建设项目(中医药发展秘〔2018〕23号)。
关键词
骨关节炎
膝
半月板
胫骨
关节镜检查
内侧副韧带
膝
小刀针
临床试验
osteoarthritis,knee
menisci,tibial
arthroscopy
medial collateral ligament,knee
small knife needle
clinical trial
