Hunt Stephen A, Jazrawi Laith M, Sherman Orrin H
Resident, NYU-Hospital for Joint Diseases, New York, NY, USA.
J Am Acad Orthop Surg. 2002 Sep-Oct;10(5):356-63. doi: 10.5435/00124635-200209000-00007.
Recent advances in instrumentation and a growing understanding of the pathophysiology of osteoarthritis have led to increased use of arthroscopy for the management of degenerative arthritis of the knee. Techniques include lavage and débridement, abrasion arthroplasty, subchondral penetration procedures (drilling and microfracture), and laser/thermal chondroplasty. In most patients, short-term symptomatic relief can be expected with arthroscopic lavage and débridement. Greater symptomatic relief and more persistent pain relief can be achieved in patients who have acute onset of pain, mechanical disturbances from cartilage or meniscal fragments, normal lower extremity alignment, and minimal radiographic evidence of degenerative disease. Arthroscopic chondroplasty techniques provide unpredictable results. Concerns include the durability of the fibrocartilage repair tissue in subchondral penetration procedures and thermal damage to subchondral bone and adjacent normal articular cartilage in laser/thermal chondroplasty. Although recent prospective, randomized, double-blinded studies have demonstrated that outcomes after arthroscopic lavage or débridement were no better than placebo procedure for knee osteoarthritis, controversy still exists. With proper selection, patients with early degenerative arthritis and mechanical symptoms of locking or catching can benefit from arthroscopic surgery.
仪器设备的最新进展以及对骨关节炎病理生理学的深入理解，使得关节镜在膝关节退行性关节炎治疗中的应用日益增多。技术包括灌洗和清创、磨削关节成形术、软骨下穿透手术（钻孔和微骨折）以及激光/热软骨成形术。在大多数患者中，关节镜灌洗和清创有望带来短期症状缓解。对于那些疼痛急性发作、存在软骨或半月板碎片导致的机械性干扰、下肢对线正常且退行性疾病影像学证据极少的患者，可实现更大程度的症状缓解和更持久的疼痛缓解。关节镜软骨成形术技术的效果难以预测。问题包括软骨下穿透手术中纤维软骨修复组织的耐久性，以及激光/热软骨成形术中软骨下骨和相邻正常关节软骨的热损伤。尽管最近的前瞻性、随机、双盲研究表明，关节镜灌洗或清创治疗膝关节骨关节炎的效果并不优于安慰剂手术，但争议仍然存在。经过适当筛选，早期退行性关节炎且有锁定或卡顿等机械症状的患者可从关节镜手术中获益。
