Lotto Marie L, Wright Emma J, Appleby David, Zelicof Steven B, Lemos Mark J, Lubowitz James H
Endoscopy Division, Smith & Nephew, Andover, Massachusetts, USA.
Arthroscopy. 2008 Apr;24(4):410-5. doi: 10.1016/j.arthro.2007.09.018. Epub 2008 Jan 7.
The purpose of this study was to evaluate tissue effect (tissue removal plus underlying cell death) of two chondroplasty techniques: mechanical debridement (MD) using a rotary shaver blade and thermal chondroplasty using radiofrequency energy (RFE).
Forty-eight human chondromalacic cartilage samples were treated with either MD or RFE. Pre- and post-treatment arthroscopic images of the cartilage surface were recorded. Samples were incubated with cell viability stain and visualized with confocal laser microscopy to determine tissue effect. Smoothing was quantitated by three surgeons using a visual analog scale (VAS) as well as a subjective rating regarding whether smoothing was "arthroscopically acceptable."
Tissue effect at the surgical endpoint of arthroscopically acceptable smoothing was 385 microm for MD versus 236 microm for RFE, a significant difference (P < .0001). Mean post-treatment VAS for MD was 2.8 points less smooth than for RFE (P < .0001). Overall, arthroscopically acceptable smoothing was achieved in 90% of RFE samples compared to 49% of MD samples.
Our results shown that chondroplasty using a RFE probe results in greater smoothing of chondromalacic cartilage in fewer treatment passes and with decreased total tissue effect than MD using a rotary shaver blade.
If safety and efficacy can be shown in vivo, thermal chondroplasty may represent an alternative for treatment of symptomatic chondromalacia.
本研究旨在评估两种软骨成形术技术的组织效应（组织切除加深层细胞死亡）：使用旋转刨刀刀片的机械清创术（MD）和使用射频能量（RFE）的热软骨成形术。
48个人类软骨软化症软骨样本分别接受MD或RFE治疗。记录软骨表面治疗前后的关节镜图像。样本用细胞活力染色孵育，并用共聚焦激光显微镜观察以确定组织效应。由三名外科医生使用视觉模拟量表（VAS）以及关于平滑度是否“关节镜下可接受”的主观评分对平滑度进行定量。
关节镜下可接受的平滑度手术终点处的组织效应，MD为385微米，RFE为236微米，差异有统计学意义（P <.0001）。MD治疗后的平均VAS比RFE少2.8分（P <.0001）。总体而言，90%的RFE样本实现了关节镜下可接受的平滑度，而MD样本为49%。
我们的结果表明，与使用旋转刨刀刀片的MD相比，使用RFE探头进行软骨成形术能在更少的治疗次数内使软骨软化症软骨获得更大程度的平滑度，且总组织效应降低。
如果能在体内证明安全性和有效性，热软骨成形术可能是治疗症状性软骨软化症的一种替代方法。
