膝关节外侧间室骨关节炎患者的关节镜下外侧半月板切除术：一项病例系列研究

Arthroscopic lateral meniscectomy in knees with lateral compartment osteoarthritis: a case series study.

作者信息

Kuraishi Joji, Akizuki Shaw, Takizawa Tsutomu, Yamazaki Ikuya, Matsunaga Daigo

机构信息

Department of Orthopaedic Surgery, Nagano Matsushiro General Hospital, Nagano, Japan.

出版信息

Arthroscopy. 2006 Aug;22(8):878-83. doi: 10.1016/j.arthro.2006.04.080.

DOI:10.1016/j.arthro.2006.04.080

PMID:16904587

Abstract

PURPOSE

The purpose of this study was to investigate the intermediate-term postoperative results of arthroscopic surgery for lateral compartment osteoarthritis (OA) of the knee in a case series study.

METHODS

In a series of 30 knees in 29 patients who underwent arthroscopic surgery for lateral compartment OA, we were able to observe 25 joints in 24 patients prospectively for the entire postoperative period. The follow-up period ranged from 1 to 13 years, with a mean of 5.5 +/- 3.7 years. The procedure in all cases comprised lateral partial meniscectomy with either abrasion arthroplasty, or debridement of the articular cartilage surface or microfracture. Of 25 cases, 13 underwent abrasion arthroplasty, 10 underwent debridement of the articular cartilage surface, and 2 underwent microfracture. Results were assessed by use of the postoperative knee score, findings of arthritic changes on plain knee radiographs, and other measurements of postoperative progress.

RESULTS

Further surgery was required in 2 cases (8%) because of poor postoperative progress. In the remaining 22 patients, knee scores improved from a mean of 52.4 points preoperatively to 84.6 points postoperatively and mean function scores improved from 45.4 points to 82.6 points, with these favorable results being maintained at the last follow-up. The femoral-tibial angle decreased slightly as each year passed postoperatively. Radiologic progression of OA was seen at 3 years postoperatively in 7 patients (28%), but no progression was seen in 12 (48%). A positive correlation was seen between the preoperative femoral-tibial angle and postoperative results (R = 0.81, P < .01).

CONCLUSIONS

When lateral compartment OA and lateral meniscal tears are both present, the clinical outcome of lateral meniscal resection was favorable. In patients with lateral compartment OA, therefore, an arthroscopic procedure, including meniscectomy, should be considered early.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

本病例系列研究旨在探讨膝关节外侧间室骨关节炎（OA）关节镜手术的中期术后结果。

方法

在29例接受膝关节外侧间室OA关节镜手术的患者的30个膝关节中，我们前瞻性地观察了24例患者的25个关节的整个术后时期。随访期为1至13年，平均为5.5±3.7年。所有病例的手术均包括外侧部分半月板切除术，同时进行磨削成形术、关节软骨表面清创术或微骨折术。25例患者中，13例行磨削成形术，10例行关节软骨表面清创术，2例行微骨折术。通过术后膝关节评分、膝关节X线平片上的关节炎变化结果以及术后进展的其他测量指标来评估结果。

结果

2例（8%）因术后进展不佳需要进一步手术。其余22例患者中，膝关节评分从术前的平均52.4分提高到术后的84.6分，平均功能评分从45.4分提高到82.6分，这些良好结果在最后一次随访时得以维持。术后每年股骨-胫骨角略有下降。7例患者（28%）在术后3年出现OA的放射学进展，但12例（48%）未见进展。术前股骨-胫骨角与术后结果之间存在正相关（R = 0.81，P <.01）。