Chang R W, Falconer J, Stulberg S D, Arnold W J, Manheim L M, Dyer A R
Multipurpose Arthritis Center, Northwestern University, Chicago, IL 60611.
Arthritis Rheum. 1993 Mar;36(3):289-96. doi: 10.1002/art.1780360302.
To compare arthroscopic surgery and closed-needle joint lavage for patients with non-end-stage osteoarthritis (OA) of the knee under controlled, experimental conditions.
Thirty-two subjects who met specific clinical, radiologic, medical, and rehabilitation criteria were randomized to receive arthroscopic surgery (n = 18) or joint lavage (n = 14). Outcome measures evaluated at baseline and at 3 and 12 months of followup included 3 standard clinical parameters, self-reported pain and functional status (by the Arthritis Impact Measurement Scales), 50-foot walk time, 2 global scales, and direct and indirect medical costs.
At 3 months of followup, there were no significant between-group differences in pain, self-reported and observed functional status, and patient and "blinded" physician global assessments. The arthroscopic procedure cost $3,840 more than did closed-needle joint lavage. After 1 year, there were no between-group differences in medication costs, utilization of medical services, or indirect costs related to employment or use of household help. After 1 year, 44% of subjects who underwent arthroscopy reported improvement and 58% of subjects who underwent joint lavage improved. Patients with tears of the anterior two-thirds of the medial meniscus or any lateral meniscus tear had a higher probability of improvement (by "blinded" physician assessment) after arthroscopic surgery (0.63) than did patients with other intraarticular pathology (0.20).
The search for and removal of soft tissue abnormalities via arthroscopic surgery does not appear justified for all patients with non-end-stage OA of the knee who fail to respond to conservative therapy, but it may be beneficial for certain subgroups.
在可控的实验条件下，比较关节镜手术与闭合针关节灌洗术治疗非终末期膝骨关节炎（OA）患者的效果。
32名符合特定临床、放射学、医学和康复标准的受试者被随机分为接受关节镜手术组（n = 18）或关节灌洗组（n = 14）。在基线以及随访3个月和12个月时评估的结果指标包括3项标准临床参数、自我报告的疼痛和功能状态（通过关节炎影响测量量表）、50英尺步行时间、2项整体量表以及直接和间接医疗费用。
在随访3个月时，两组在疼痛、自我报告和观察到的功能状态以及患者和“盲法”医生的整体评估方面没有显著差异。关节镜手术的费用比闭合针关节灌洗术高出3840美元。1年后，两组在药物费用、医疗服务利用或与就业或使用家庭帮助相关的间接费用方面没有差异。1年后,接受关节镜手术治疗的受试者中有44%报告病情改善，接受关节灌洗治疗的受试者中有58%病情改善。内侧半月板前三分之二撕裂或任何外侧半月板撕裂的患者在接受关节镜手术后（根据“盲法”医生评估）改善的可能性（0.63）高于患有其他关节内病变的患者（0.20）。
对于所有对保守治疗无反应的非终末期膝OA患者，通过关节镜手术寻找并清除软组织异常似乎并不合理，但对某些亚组患者可能有益。
