Bernstein Joseph, Quach Tony
Department of Orthopedic surgery, University of Pennsylvania, Philadelphia, USA.
Cleve Clin J Med. 2003 May;70(5):401, 405-6, 408-10. doi: 10.3949/ccjm.70.5.401.
Arthroscopy for degenerative conditions of the knee is among the most commonly employed orthopedic procedures, but its effectiveness (like the effectiveness of many surgical operations) has never been proven in prospective trials. Moreover, the precise mechanism by which arthroscopy improves the course of degenerative conditions of the knee has not been established conclusively. Moseley et al performed a double-blinded, randomized, placebo-controlled trial to compare the effectiveness of arthroscopic lavage and arthroscopic debridement vs a sham procedure. Data regarding pain and function were obtained at multiple time points over a 2-year period. The authors found that all three treatment groups fared equally: each reported subjective symptomatic relief, but no objective improvement in function was noted in any of the groups. These data suggest that the benefits of arthroscopy for the treatment of osteoarthritis of the knee is to provide subjective pain relief, and that the means by which arthroscopy provides this benefit is via a placebo effect.
关节镜检查用于治疗膝关节退行性疾病是最常用的骨科手术之一，但它的有效性（如同许多外科手术的有效性一样）从未在前瞻性试验中得到证实。此外，关节镜检查改善膝关节退行性疾病病程的确切机制尚未最终确定。莫斯利等人进行了一项双盲、随机、安慰剂对照试验，以比较关节镜灌洗和关节镜清创与假手术的有效性。在两年的时间里，在多个时间点获取了有关疼痛和功能的数据。作者发现，所有三个治疗组的情况相同：每组都报告主观症状有所缓解，但在任何一组中均未观察到功能有客观改善。这些数据表明，关节镜检查治疗膝关节骨关节炎的益处在于提供主观疼痛缓解，而关节镜检查提供这种益处的方式是通过安慰剂效应。
