全膝关节置换术中滑膜切除术的长期结果：一项前瞻性、随机对照试验。

Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial.

机构信息

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China.

出版信息

Chin Med J (Engl). 2023 Jan 5;136(1):73-81. doi: 10.1097/CM9.0000000000002205.

DOI:10.1097/CM9.0000000000002205

PMID:36780427

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10106132/

Abstract

BACKGROUND

Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.

METHODS

This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.

RESULTS

At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P > 0.05).

CONCLUSIONS

Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .

摘要

背景

滑膜切除术已被引入全膝关节置换术（TKA）中，旨在缓解滑膜的疼痛和炎症。然而，目前尚无长期、对比的数据来评估滑膜切除术在 TKA 中的效果。本研究旨在评估在骨关节炎（OA）的 TKA 中进行滑膜切除术的患者在长期随访中的疼痛、功能和并发症。

方法

这是一项前瞻性随机对照试验，共纳入 42 例连续接受分期双侧 TKA 的患者。接受一侧 TKA 的患者被分配接受 TKA 联合或不联合滑膜切除术，然后进行 3 个月的洗脱期，并交叉到另一侧 TKA 的另一种策略。通过术后 3 个月内的失血量、膝关节协会评分（KSS）和膝关节炎症情况来评估两种策略的整体疗效。术后疼痛、关节活动度（ROM）和并发症进行了序贯评估，直到术后 10 年。

结果

在 10 年的随访中，两组的 ROM（114.88 ± 9.84° vs. 114.02 ± 9.43°，t = 0.221，P = 0.815）和疼痛缓解均有显著改善，两组间无差异；两组术后 3 个月内的总失血量、KSS 和膝关节炎症均有相似的变化（P > 0.05）。此外，两组间并发症和满意度无显著差异（P > 0.05）。