老年骨关节炎患者的膝关节镜清创术效果可能令人满意。
Arthroscopic knee debridement in osteoarthritis in the older age can be satisfactory.
作者信息
Fuchs Lee, Givon Assaf, Shweiki Fadi, Hovav Tavor
机构信息
Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel.
出版信息
J Clin Orthop Trauma. 2023 Feb 13;38:102130. doi: 10.1016/j.jcot.2023.102130. eCollection 2023 Mar.
INTRODUCTION
Knee arthroscopy is one of the treatments for knee pain. In recent years, the use of knee arthroscopy in the treatment of osteoarthritis was challenged by several randomized-controlled trials, systematic reviews and meta-analyses. However, some design flaws are making the clinical decision harder. This study specifically explores the patient satisfaction from these surgeries to aid in clinical decision.
HYPOTHESIS
Knee arthroscopy can relieve symptoms and delay further surgical treatment in the older age.
PATIENTS & METHODS: Fifty patients accepted participation and were invited to a follow-up examination eight years post knee arthroscopy. All patients were above age 45 and diagnosed with degenerative meniscus tear and osteoarthritis. The patients filled follow-up questionnaires of function (WOMAC, IKDC, SF-12) and pain. The patients were asked to appreciate if they would have repeated the surgery retrospectively. The results were compared to a previous data base.
RESULTS
Thirty-six patients (72%) reported satisfaction of 8 and above (scale of 0-10) from the surgery and would have repeated it. A higher SF-12 physical score pre-surgery predicted a higher satisfaction rate (p = 0.027). Patients who were more satisfied from the surgery improved post-surgery in all parameters compared with the less-satisfied group (p < 0.001). Patients above the age 60 had similar parameters pre- and post-surgery compared with patients under the age 60 (p > 0.05).
CONCLUSIONS
Patients between the ages 46-78 with degenerative meniscus tear and osteoarthritis felt they benefited from knee arthroscopy in an eight-year follow-up and would repeat the surgery. Our research may help with better patient selection and suggest knee arthroscopy can relive symptoms and delayed further surgical treatment for the older patient with clinical symptoms and signs of meniscus related pain, mild osteoarthritis, and failed conservative treatment.
LEVEL OF EVIDENCE
IV.
引言
膝关节镜检查是治疗膝关节疼痛的方法之一。近年来，膝关节镜检查在骨关节炎治疗中的应用受到了多项随机对照试验、系统评价和荟萃分析的质疑。然而，一些设计缺陷使得临床决策更加困难。本研究专门探讨患者对这些手术的满意度，以辅助临床决策。
假设
膝关节镜检查可以缓解症状，并延缓老年患者进一步的手术治疗。
患者与方法
50名患者接受了研究，并被邀请在膝关节镜检查8年后进行随访检查。所有患者年龄均在45岁以上，诊断为退行性半月板撕裂和骨关节炎。患者填写了功能（WOMAC、IKDC、SF-12）和疼痛的随访问卷。患者被要求回顾性评价是否会再次接受该手术。结果与先前的数据库进行了比较。
结果
36名患者（72%）报告对手术的满意度为8分及以上（0-10分制），并愿意再次接受手术。术前较高的SF-12身体评分预示着较高的满意度（p = 0.027）。与满意度较低的组相比，对手术更满意的患者在所有参数上术后均有改善（p < 0.001）。60岁以上患者术前和术后的参数与60岁以下患者相似（p > 0.05）。
结论
在8年的随访中，年龄在46-78岁之间、患有退行性半月板撕裂和骨关节炎的患者认为他们从膝关节镜检查中获益，并愿意再次接受手术。我们研究可能有助于更好地选择患者，并表明膝关节镜检查可以缓解症状，并延缓有半月板相关疼痛、轻度骨关节炎临床症状体征且保守治疗失败的老年患者进一步的手术治疗。
证据级别
IV级
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