Bailey O, Gronkowski K, Leach W J
Western Infirmary Glasgow, United Kingdom.
National Services Scotland, United Kingdom.
Knee. 2015 Mar;22(2):95-9. doi: 10.1016/j.knee.2014.12.008. Epub 2014 Dec 27.
Current evidence suggests limiting arthroscopic meniscectomy to those patients with no or early arthritis however outcomes of arthroscopic meniscectomy with patients of a higher body mass index (BMI) are not as widely available. The aim of this study was to determine if patient reported outcome scores for arthroscopic meniscectomy are adversely affected by the degree of knee osteoarthritis or patient BMI.
All patients who underwent arthroscopic meniscectomy within the NHS in Scotland between the 6th of February and 29th of April 2012 were audited as part of the Scottish Government Musculoskeletal Audit and were eligible for inclusion within this study. A total of 270 patients returned both their pre-operative and post-operative EuroQol 5Q5D5L descriptive questionnaire and Knee injury and Osteoarthritis Outcomes Scores. Patients were stratified according to BMI, degree of osteoarthritis, history of injury, and duration of knee symptoms.
Pre-operative to post-operative EuroQol index scores [0.642±0.253 to 0.735±0.277, median±SD] and Knee injury and Osteoarthrtis Outcome Scores [44.63±18.78 to 62.28±24.94, median±SD] improved across all patients (p<0.0001). This was irrespective of degree of BMI, history of injury, or duration of symptoms. There was no such improvement in patients with moderate to severe osteoarthritis. Those patients with a BMI >35 kg/m2 had lower post-operative scores than the pre-operative scores of those of BMI <30 kg/m2.
Arthroscopic meniscectomy is beneficial regardless of patient BMI, duration of symptoms, history of injury, or in the presence of early osteoarthritis.
目前的证据表明,关节镜下半月板切除术应限于那些没有关节炎或仅有早期关节炎的患者,然而,关于体重指数(BMI)较高的患者接受关节镜下半月板切除术的结果,相关资料并不多见。本研究的目的是确定关节镜下半月板切除术患者报告的结局评分是否会受到膝关节骨关节炎程度或患者BMI的不利影响。
2012年2月6日至4月29日期间在苏格兰国民保健制度(NHS)接受关节镜下半月板切除术的所有患者,作为苏格兰政府肌肉骨骼审计的一部分接受了审核,并有资格纳入本研究。共有270名患者返回了术前和术后的欧洲五维健康量表(EuroQol 5Q5D5L)描述性问卷以及膝关节损伤和骨关节炎结局评分。患者根据BMI、骨关节炎程度、损伤史和膝关节症状持续时间进行分层。
所有患者的术前至术后欧洲五维健康量表指数评分[0.642±0.253至0.735±0.277,中位数±标准差]和膝关节损伤和骨关节炎结局评分[44.63±18.78至62.28±24.94,中位数±标准差]均有所改善(p<0.0001)。这与BMI程度、损伤史或症状持续时间无关。中度至重度骨关节炎患者没有这种改善。BMI>35 kg/m²的患者术后评分低于BMI<30 kg/m²患者的术前评分。
无论患者的BMI、症状持续时间、损伤史如何,或是否存在早期骨关节炎,关节镜下半月板切除术都是有益的。