膝关节骨性关节炎应用关节镜治疗的探讨

The Therapy of Knee Osteoarthritis with Arthroscope

目的探讨膝关节骨性关节炎应用关节镜治疗的相关因素与疗效。方法58例膝关节骨性关节炎（OA）采用局麻或腰麻、关节镜下选择性，有限化关节清理术。手术包括刨削清理增生肥厚的炎性组织，修平退变剥脱的软骨创面，去除不稳定骨赘，切除和修整破损的半月板，取出游离体，髁间窝成型，解除伸膝障碍和ACL磨损。术后指导其综合康复训练并配合玻璃酸钠关节内注射。结果随诊51例，平均13个月（2～24个月）。优18例，良24例，可7例，差4例，优良率86．5％，Lyshoml评分由术前的39例，提高到术后的78分，平均提高39分。结论关节镜下微创清理术治疗骨性关节炎，术后配合康复训练和玻璃酸钠关节内注射，能有效解除临床症状，改善功能提高生活质量，但对严重关节面软骨破坏者效果不理想，以行人工膝关节置换为好。

Objective To discuss the relative factors and therapeutic efficacy of arthroscope in the treatment of osteoarthritis. Methods Fiftyeight patients suffered with knee osteoarthritis were treated with selective or limited debridement under arthroscope with local anesthesia or lumbar anesthesia. The procedures included removal of hyperplastic synovial membrane, raw surface of degenerated cartilage, loose body, repairing the worn meniscus, and reshaping the intercondyler fossa. General rehabilitation exercise was introducted and sodium hyaluronate was injected after operation. Results Fifty - tree cases were followed up for 13 months in average. Eighteen cases acquired excellent results, 24 was good, 7 was common and 4 was bad. According to Lyshoml evaluation system, the score was enhanced from 39 of preoperative to 78 of postoperative. Conclusions Minimum invasive debridement under arthroscope combining with general rehabilitation exercise and injection of sodium hyaluronate is effective in the treatment of osteoarthritis and can improve the quality of life, but doesn＇t fit the eases suffered with severely destroyed surface of cartilage which should better choice total knee prosthesis.