Jackson R W
Dept of Orthopedic Surgery, Baylor University Medical Ctr, Dallas, TX 75246, USA.
Am J Knee Surg. 1998 Winter;11(1):51-4.
Arthroscopic lavage and debridement is of significant value in the earlier stages of arthritis. This is probably through the removal or dilution of enzymes that are part of the degradative process of osteoarthritis. Mechanical problems such as meniscal tears and loose bodies also can be addressed at the same time. However, patients must be selected carefully for arthroscopic treatment. A severity scale is proposed based on clinical and radiological findings that should indicate in advance those patients who will have the greatest opportunity for improvement from an arthroscopic procedure. Critics have said that lavage and debridement does nothing to change the natural history of the disease and is no more than a placebo effect. While there is no strong evidence to suggest that it does modify the natural history of the disease, it definitely improves the quality of life for a significant period of time, with little in the way of complications or morbidity associated with the procedure. The placebo effect might explain some of the results, but the placebo effect is well-known in medicine, and if it does produce a positive result in terms of reduction of symptoms, it cannot be entirely discounted. The biological resurfacing of a joint under arthroscopic control is the challenge facing orthopedic surgeons today. Healing and restoration of articular tissues back to some functional biological state would seem to be a reasonable goal. If this can be achieved, the future will lie in the salvage of joints through arthroscopic procedures rather than the replacement of joints by arthroplasty.
关节镜灌洗和清创术在关节炎早期具有重要价值。这可能是通过去除或稀释作为骨关节炎降解过程一部分的酶来实现的。半月板撕裂和游离体等机械性问题也可同时得到处理。然而，必须谨慎选择接受关节镜治疗的患者。基于临床和影像学检查结果提出了一种严重程度分级标准，该标准应提前指出哪些患者从关节镜手术中改善的机会最大。批评者称灌洗和清创术对改变疾病的自然病程毫无作用，只不过是安慰剂效应。虽然没有有力证据表明它确实能改变疾病的自然病程，但它肯定能在相当长一段时间内改善生活质量，且该手术几乎没有并发症或发病率。安慰剂效应可能解释了部分结果，但安慰剂效应在医学上是众所周知的，如果它在减轻症状方面确实产生了积极效果，就不能完全被忽视。在关节镜控制下实现关节的生物性修复是当今骨科医生面临的挑战。将关节组织愈合并恢复到某种功能性生物状态似乎是一个合理的目标。如果能够实现这一点，未来将在于通过关节镜手术挽救关节，而不是通过关节置换术来替换关节。
