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清创关节镜检查。10年随访。

Debridement arthroscopy. 10-year followup.

作者信息

McGinley B J, Cushner F D, Scott W N

机构信息

Mather Hospital and St. Charles Hospital, Port Jefferson, NY, USA.

出版信息

Clin Orthop Relat Res. 1999 Oct(367):190-4.

Abstract

The treatment of osteoarthritis of the knee is a difficult problem. In the senior author's opinion, nonaggressive arthroscopic debridement of the knee is an effective procedure to relieve pain and restore function in patients with osteoarthritis of the knee. A subjective telephone interview of patients done 10 or more years after arthroscopic debridement evaluated the long term results of this treatment in patients with osteoarthritis of the knee. The patients all were candidates for total knee replacement who selected arthroscopy as a temporizing procedure. Of the 191 knees in patients undergoing arthroscopic debridement, 77 patients (91 knees) were contacted for followup. Sixty-seven percent of the 91 knees did not have total knee arthroplasty at an average of 13.2 years followup. The Tegner activity score averaged 3.5 and patient satisfaction averaged 8.6 on a 0 to 10 scale. Twenty-one patients (30 knees) or (33%) had total knee arthroplasty at an average of 6.7 years. Seven of these had total knee arthroplasty within 2 years of arthroscopic debridement. Six of these seven knees had Outerbridge Grade 4 articular cartilage changes and clinically significant meniscus tears. Seven of the 19 knees (37%) with Outerbridge Grade 4 changes in 80% of one knee compartment did not require total knee arthroplasty after greater than 10 year followup. The difficulties in long term followup in this patient population is evident, yet the number of patients who had a functional lifestyle after arthroscopic debridement was notable.

摘要

膝关节骨关节炎的治疗是一个难题。在资深作者看来,膝关节的非激进性关节镜清理术是缓解膝关节骨关节炎患者疼痛并恢复功能的有效方法。在关节镜清理术后10年或更长时间对患者进行主观电话访谈,评估了这种治疗方法对膝关节骨关节炎患者的长期效果。这些患者均为全膝关节置换术的候选者,他们选择关节镜检查作为一种临时治疗手段。在接受关节镜清理术的患者的191个膝关节中,联系到了77名患者(91个膝关节)进行随访。在平均13.2年的随访中,91个膝关节中有67%未进行全膝关节置换术。Tegner活动评分平均为3.5,患者满意度在0至10分的量表上平均为8.6。21名患者(30个膝关节)或33%在平均6.7年时进行了全膝关节置换术。其中7名患者在关节镜清理术后2年内进行了全膝关节置换术。这7个膝关节中有6个存在Outerbridge 4级关节软骨改变和临床上显著的半月板撕裂。在一个膝关节腔80%出现Outerbridge 4级改变的19个膝关节中,有7个(37%)在随访超过10年后未进行全膝关节置换术。对这一患者群体进行长期随访存在困难是显而易见的,但关节镜清理术后能保持功能性生活方式的患者数量是值得注意的。

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