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基于 CT 分类的关节镜下骨囊关节成形术治疗晚期原发性肘关节炎。

Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification.

机构信息

Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China.

出版信息

J Shoulder Elbow Surg. 2020 May;29(5):989-995. doi: 10.1016/j.jse.2019.09.036. Epub 2019 Dec 9.

Abstract

HYPOTHESIS

Arthroscopic osteocapsular arthroplasty for stage III osteoarthritis (advanced stage) shows worse clinical and radiologic outcomes compared with stage I or II according to computed tomography (CT)-based classification.

METHODS

Clinical and radiologic outcomes in 65 patients treated with arthroscopic osteocapsular arthroplasty were retrospectively analyzed for range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Patients were classified into stage I or II (n = 44) and stage III (n = 21) groups according to CT-based classification, and postoperative clinical outcomes and complications were analyzed.

RESULTS

Mean follow-up duration was 32.9 ± 13.7 months (range, 24-69). The average patient age was 52 ± 10 years (range, 40-63). Improvements from preoperative to final follow-up were seen in the overall ROM-flexion from 94° ± 19° to 129° ± 14° (P < .01), ROM-extension from 25° ± 12° to 14° ± 7° (P < .01), MEPS from 45 ± 13 to 78 ± 14 (P < .01), and VAS score from 6.3 ± 1.6 to 3.1 ± 1.4 (P < .01). Subgroup analysis using the CT-based classification revealed that stage III led to worsened VAS score and MEPS than stage I or II.

CONCLUSIONS

Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. However, stage III shows worse clinical and radiologic outcomes compared with stage I or II according to CT-based classification.

摘要

假设

根据基于 CT 的分类,与 I 期或 II 期相比,关节镜下骨囊成形术治疗 III 期(晚期)骨关节炎的临床和影像学结果较差。

方法

回顾性分析 65 例接受关节镜下骨囊成形术治疗的患者的临床和影像学结果,包括关节活动度(ROM)弧、功能评分(梅奥肘功能评分 [MEPS])和疼痛评分(视觉模拟评分 [VAS])。根据 CT 分类将患者分为 I 期或 II 期(n = 44)和 III 期(n = 21)两组,分析术后临床结果和并发症。

结果

平均随访时间为 32.9 ± 13.7 个月(范围 24-69)。平均患者年龄为 52 ± 10 岁(范围 40-63)。从术前到最终随访,总体 ROM-屈曲从 94°±19°增加到 129°±14°(P<.01),ROM-伸展从 25°±12°增加到 14°±7°(P<.01),MEPS 从 45±13 增加到 78±14(P<.01),VAS 评分从 6.3±1.6 减少到 3.1±1.4(P<.01)。使用基于 CT 的分类进行的亚组分析显示,III 期的 VAS 评分和 MEPS 均比 I 期或 II 期差。

结论

关节镜下骨囊成形术可推荐用于治疗肘关节炎,总体治疗效果良好。然而,根据基于 CT 的分类,与 I 期或 II 期相比,III 期的临床和影像学结果较差。

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