使用针式关节镜进行部分半月板切除术在术后两周时疼痛明显减轻，患者报告的结果也有所改善：与标准膝关节镜检查的比较。
Partial meniscectomy using needle arthroscopy associated with significantly less pain and improved patient reported outcomes at two weeks after surgery: A comparison to standard knee arthroscopy.
作者信息
Schaver Andrew L, Lash Jonathan G, MacAskill Micah L, Taylor Shane, Hewett Timothy E, Jasko John J, Argintar Evan H, Lavender Chad D
机构信息
Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA.
MedStar Orthopaedic Institute, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA.
出版信息
J Orthop. 2023 Jun 7;41:63-66. doi: 10.1016/j.jor.2023.06.003. eCollection 2023 Jul.
PURPOSE
to compare immediate post-operative pain and patient-reported outcomes (PROs) after partial meniscectomy with needle (NA) vs. standard (SA) arthroscopy technique.
METHODS
A retrospective review of a consecutive series of patients who underwent partial meniscectomy before and after adoption of a needle arthroscopic technique was performed. Meniscus repairs, root repairs, and those with ligamentous injuries were excluded. Total milligram morphine equivalents (MMEs) consumed, Visual analog scale (VAS) pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were compared pre-operatively and at 2 and 6-weeks postoperatively. Univariate analysis was used to compare results.
RESULTS
Nineteen patients were in each group (NA: 10 females, SA: 11 females). Mean ± SD age (NA 42.8 ± 8.4 vs. SA 47.6 ± 10.4 years, p = 0.13) and body mass index (NA 31.4 ± 5.6 vs. SA 35.1 ± 5.4 m/kg, p = 0.06) were not significantly different. Seventeen (89%) patients in both groups had medial meniscus tears of the posterior horn. Preoperative Outerbridge score was significantly greater in the SA group (3.4 vs. 1.8, p = 0.002); however, preoperative VAS pain (NA 6.1 ± 1.7 vs. SA 6.1 ± 1.8, p = 0.98) and KOOS pain (NA 44 ± 17% vs. SA 37 ± 12.5%, p = 0.20) were similar. Amount of arthroscopic fluid used was significantly greater in the SA vs. NA group (1.4 ± 0.7 vs. 0.5 ± 0.3 L, p < 0.0001), but tourniquet time was equivalent (NA 20 ± 6 vs.16 ± 6 min, p = 0.11). VAS pain scores (NA 1.0 ± 1.1 vs. SA 2.6 ± 1.5, p = 0.0014), KOOS pain (NA 79 ± 15% vs. 58 ± 19%, p = 0.0006), and Quality of Life (QOL) scores (NA 70 ± 22% vs. SA 43 ± 24%, p = 0.001) were significantly better at 2-weeks post-op in the N group. By 6 weeks post-op, all PROs including VAS pain and KOOS scores were similar between groups.
CONCLUSIONS
Adoption of a needle arthroscopic technique for partial meniscectomy was associated with significantly improved VAS and KOOS pain scores two-weeks post-operatively. Differences were not sustained at 6 weeks after surgery.
LEVEL OF EVIDENCE
III, Retrospective Comparison Study.
目的
比较采用穿刺针（NA）与标准（SA）关节镜技术进行半月板部分切除术后的即时疼痛及患者报告结局（PROs）。
方法
对在采用穿刺针关节镜技术前后接受半月板部分切除术的一系列连续患者进行回顾性研究。排除半月板修复、根部修复及伴有韧带损伤的患者。比较术前、术后2周和6周时消耗的吗啡总毫克当量（MMEs）、视觉模拟量表（VAS）疼痛评分以及膝关节损伤和骨关节炎结局评分（KOOS）。采用单因素分析比较结果。
结果
每组各有19例患者（NA组：10例女性，SA组：11例女性）。平均年龄±标准差（NA组42.8±8.4岁，SA组47.6±10.4岁，p = 0.13）和体重指数（NA组31.4±5.6，SA组35.1±5.4 m/kg，p = 0.06）无显著差异。两组中17例（89%）患者为后角内侧半月板撕裂。SA组术前Outerbridge评分显著更高（3.4对1.8，p = 0.002）；然而，术前VAS疼痛评分（NA组6.1±1.7，SA组6.1±1.8，p = 0.98）和KOOS疼痛评分（NA组44±17%，SA组37±12.5%，p = 0.20）相似。SA组使用的关节镜冲洗液量显著多于NA组（1.4±0.7对0.5±0.3 L，p < 0.0001），但止血带使用时间相当（NA组20±6分钟，SA组16±6分钟，p = 0.11）。术后2周时，NA组的VAS疼痛评分（1.0±1.1对SA组2.6±1.5，p = 0.0014）、KOOS疼痛评分（NA组79±15%，SA组58±19%，p = 0.0006）及生活质量（QOL）评分（NA组70±22%，SA组43±24%，p = 0.001）均显著更好。术后6周时，包括VAS疼痛评分和KOOS评分在内的所有PROs在两组间相似。
结论
采用穿刺针关节镜技术进行半月板部分切除术与术后2周时VAS和KOOS疼痛评分显著改善有关。术后6周时差异未持续存在。
证据级别
III，回顾性比较研究。
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