膝关节骨关节炎的关节镜治疗方案

An arthroscopic treatment regimen for osteoarthritis of the knee.

作者信息

Steadman J Richard, Ramappa Arun J, Maxwell R Brian, Briggs Karen K

机构信息

Steadman Hawkins Research Foundation, Vail, Colorado 81657, USA.

出版信息

Arthroscopy. 2007 Sep;23(9):948-55. doi: 10.1016/j.arthro.2007.03.097.

DOI:10.1016/j.arthro.2007.03.097

PMID:17868833

Abstract

PURPOSE

The purpose of this study was to evaluate the functional and subjective outcomes of patients with moderate to severe osteoarthritis of the knee who underwent a comprehensive arthroscopic treatment regimen.

METHODS

Between August 2000 and November 2001, 69 knees in 61 patients were treated with an arthroscopic regimen. Inclusion criteria included severe osteoarthritis and a minimum 2-year follow-up. Arthroscopic treatment included joint insufflation, lysis of adhesions, anterior interval release, contouring of cartilage defects to a stable rim, shaping of meniscus tears to a stable rim, synovectomy, removal of loose bodies, and removal of osteophytes that affected terminal extension. Exclusion criteria included the treatment of chondral defects with microfracture. Failure was defined as knees requiring arthroplasty because this was what patients were trying to avoid.

RESULTS

The average patient age was 57 (range, 37-78), with 35 men and 26 women. Patients had an average of 1.5 previous surgeries (range, 0-12). The average preoperative Lysholm score was 49 (range, 14-79). On average, knees were insufflated with 170 mL of lactated Ringer's solution (range, 120-240). Nine knees failed, with survivorship of 83% at 3 years. At an average follow-up of 31 months (range, 24-41), the average Lysholm score was 74 (range, 37-100), with an average improvement of 25 points. The average Tegner score was 4 (range, 0-8). Average patient satisfaction was 8 (range, 1-10). The average Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score was 4 (range, 0-14), WOMAC stiffness was 2 (range, 0-4), and WOMAC function was 11 (range, 0-44). Independent predictors of improvement in Lysholm score included a shift in the weight-bearing axis and preoperative Lysholm score.

CONCLUSIONS

This arthroscopic treatment regimen can improve function and activity levels in patients with moderate to severe osteoarthritis. Of 69 patients, 60 (87%) patients had a satisfactory result. However, in this group of 60, 11 patients needed a second procedure, resulting in a 71% satisfactory result after 1 surgery.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

本研究的目的是评估接受综合关节镜治疗方案的中重度膝关节骨关节炎患者的功能和主观结果。

方法

2000年8月至2001年11月期间，对61例患者的69个膝关节进行了关节镜治疗方案。纳入标准包括严重骨关节炎和至少2年的随访。关节镜治疗包括关节充气、粘连松解、前间隙松解、将软骨缺损修整至稳定边缘、将半月板撕裂修整至稳定边缘、滑膜切除术、清除游离体以及清除影响终末伸展的骨赘。排除标准包括用微骨折治疗软骨缺损。失败定义为需要进行关节置换术的膝关节，因为这是患者试图避免的情况。

结果

患者平均年龄为57岁（范围37 - 78岁），其中男性35例，女性26例。患者平均既往手术次数为1.5次（范围0 - 12次）。术前平均Lysholm评分为49分（范围14 - 79分）。平均而言，膝关节注入170 mL乳酸林格氏液（范围120 - 240 mL）。9个膝关节治疗失败，3年生存率为83%。平均随访31个月（范围24 - 41个月），平均Lysholm评分为74分（范围37 - 100分），平均改善25分。平均Tegner评分为4分（范围0 - 8分）。患者平均满意度为8分（范围1 - 10分）。西安大略和麦克马斯特大学骨关节炎指数（WOMAC）平均疼痛评分为4分（范围0 - 14分），WOMAC僵硬评分为2分（范围0 - 4分），WOMAC功能评分为11分（范围0 - 44分）。Lysholm评分改善的独立预测因素包括负重轴移位和术前Lysholm评分。