Spahn Gunter, Mückley Thomas, Kahl Enrico, Hofmann Gunther O
Center of Traumatology and Orthopaedic Surgery Eisenach, Eisenach, Germany.
Arthroscopy. 2006 Nov;22(11):1233-40. doi: 10.1016/j.arthro.2006.07.003.
This study was designed to obtain information on factors affecting the medium-term efficacy of arthroscopy (debridement or microfracturing of chondral defects) in patients with unicompartmental osteoarthritis (OA) of the knee.
A total of 156 patients (71 men and 85 women; mean age, 51.6 +/- 8.7 years [range, 37 to 69 years]) with isolated Kellgren-Lawrence grade 2 medial-compartment knee OA underwent arthroscopy and were followed up. Patients with patellofemoral or lateral-compartment OA were excluded. The Knee Injury and Osteoarthritis Outcome Score was determined in all patients. The outcome was rated poor if this score was less than 114 points or if further surgery was required. Odds ratios (ORs) were calculated by use of multiple logistic regression adjusted for significantly associated factors.
Follow-up was performed in 92.9% of the patients, at a mean of 49.2 +/- 2.1 months (range, 47 to 54 months). The outcome was poor in 104 patients (71.7%). There were no gender differences. Factors significantly associated with a poor outcome were a history of OA for greater than 24 months (OR, 3.6), obesity (OR, 8.8), smoking (OR, 3.1), medial tibial osteophytes (OR, 5.4), medial joint space width on standing radiographs of less than 5 mm (OR, 7.3), absence of effusion (OR, 6.5), absence of synovitis (OR, 6.1), presence of crystal deposits (OR, 4.3), deep tibial cartilage defect (OR, 12.5), and need for subtotal or total meniscectomy (OR, 2.2). Patients with more than 4 of these factors had significantly poorer outcomes.
The medium-term outcome of arthroscopy in unicompartmental OA of the knee is poor in about 71.7% of the cases. In this study the outcome did not depend exclusively on the articular findings. Patient age was not associated with a poor outcome. However, a history of OA for more than 2 years, obesity, smoking, tibial osteophytes, and joint space narrowing of less 5 mm were associated with a poor outcome. Patients with 4 or more of these factors should be managed with treatment other than arthroscopy.
Level IV, therapeutic case series.
本研究旨在获取有关影响膝关节单髁骨关节炎（OA）患者关节镜检查（软骨缺损清创或微骨折）中期疗效的因素的信息。
总共156例（71例男性和85例女性；平均年龄51.6±8.7岁[范围37至69岁]）孤立性Kellgren-Lawrence 2级内侧间室膝关节OA患者接受了关节镜检查并进行了随访。排除髌股关节或外侧间室OA患者。对所有患者进行膝关节损伤和骨关节炎结局评分。如果该评分低于114分或需要进一步手术，则结局评定为差。通过对显著相关因素进行校正的多因素逻辑回归计算比值比（OR）。
92.9%的患者进行了随访，平均随访时间为49.2±2.1个月（范围47至54个月）。104例患者（71.7%）结局较差。无性别差异。与结局较差显著相关的因素包括OA病史超过24个月（OR，3.6）、肥胖（OR，8.8）、吸烟（OR，3.1）、胫骨内侧骨赘（OR，5.4）、站立位X线片上内侧关节间隙宽度小于5 mm（OR，7.3）、无积液（OR，6.5）、无滑膜炎（OR，6.1）、存在晶体沉积（OR，4.3）、胫骨深层软骨缺损（OR，12.5）以及需要进行半月板次全切除或全切除（OR，2.2）。具有4种以上这些因素的患者结局明显更差。
膝关节单髁OA关节镜检查的中期结局在约71.7%的病例中较差。在本研究中，结局并非仅取决于关节检查结果。患者年龄与结局较差无关。然而，OA病史超过2年、肥胖、吸烟、胫骨骨赘以及关节间隙狭窄小于5 mm与结局较差相关。具有4种或更多这些因素的患者应采用关节镜检查以外的治疗方法。
IV级，治疗性病例系列。
