骨关节炎患者关节镜下滑膜刨削术后膝关节功能1年随访(英文)

One-year follow-up of knee joint function in patients with osteoarthritis after synovectomy under arthroscopy

背景:关节镜下清理术作为一种微创、可重复的治疗骨关节炎的作用已得到众多学者的肯定。但作为关节镜清理术标准步骤之一的滑膜刨削术,其作用近来遭到质疑。目的:探讨骨关节炎关节镜下关节清理术中滑膜刨削术的应用价值。设计:回顾性对照分析。单位:抚顺市中心医院骨科。对象:于1997-02/2000-12抚顺市中心医院骨科行膝关节骨关节炎关节镜下清理术时行滑膜刨削术65例,资料完整并且随访1年以上的患者32例,为滑膜刨削术组;2001-01/2003-11抚顺市中心医院骨科行膝关节骨关节炎关节镜下清理时未行滑膜刨削术48例,资料完整并且随访1年以上的患者30例,为对照组。方法:手术以滑膜刨削术作为干预因素进行分组,采用关节冲洗,游离体摘除,骨赘清除,半月板修整,软骨刨削,滑膜刨削术与不进行滑膜刨削术或局部滑膜刨削术对照行疗效分析。两组病例膝关节功能采用Lysholm膝关节骨关节炎评定标准于术前及术后1年进行评定,并记录手术时间,术后引流量,术后7d视觉模拟评分,术后1年膝关节Lysholm评分。主要观察指标:术前及术后1年膝关节Lysholm评分,手术时间,术后引流量,术后7d视觉模拟评分。结果:纳入患者62例,均进入结果分析。术前两组病例具可比性,Lysholm评分比较差异无显著性(t=0.127,P=0.899)。滑膜刨削术组的手术时间比对照组长,差异显著(t=9.547,P<0.001),术后引流量多。术后视觉模拟评分大于对照组,差异显著[滑膜刨削术组、对照组分别为(4.6±1.1),(2.8±1.4)分,t=6.206,P<0.001],随访1年膝关节评分比较差异无显著性[滑膜刨削术组、对照组分别为(77.6±11.9),(79.0±10.3)分,t=0.562,P=0.576]。结论:滑膜刨削术不能增加膝骨关节炎关节镜下清理术的近期疗效,相反其施术时间长,手术创伤大,术后反应重,不应在关节清理术中常规使用。

BACKGROUND： As a micro-injurying and reduplicative treatment of osteoarthritis,the arthroscopic debridement has got the affirmation of numerous scholars.But as one of the standard procedures in artnroscopic debridement,synovectomy is called in question recently. OBJECTIVE： To explore the applied value of synovectomy in the arthroscopic debridement of osteoarthritis. DESIGN： Retrospective controlled analysis. SETTING： Department of Orthopaedics, Fushun Central Hospital. PARTICIPANTS： Sixty-five patients received synovectomy in the arthroscopic debridement of knee joint osteoarthritis in the Department of Orthopaedics,Fushun Central Hospital from February 1997 to December 2000.Thirty-two among them,with complete data and over 1 year＇s followup,were taken for synovectomy group.Forty-eight patients received the arthroscopic debridement of knee joint osteoarthritis without synovectomy in the Department of Orthopaedics,Fushun Central Hospital from January 2001 to November 2003.Thirty among them,wlth complete data and over 1 year＇s follow-up,were taken for control group. METHODS： Synovectomy was taken as the factor of intervention in the operation to perform grouping.The analysis of curative effect was performed to control with joint douching,corpus liberum removal,osteophyma cleaning, meniscus fitting,cartilage gouging,synovectomy and without synovectomy or part synovectomy.Lysholm evaluation standard of knee joint osteoarthritis was used to the knee joint functional evaluation beween preoperation and postoperative 1 year in two groups.And operative time, postoperative draining quantity,postoperative 7-day visual analog score,postoperative 1-year Lysholm score of knee joint, were recorded. MAIN OUTCOME MEASURES： Preoperative and postoperative 1-year Lysholm score of knee joint,operative time,postoperative draining quantity, postoperative 7-day visual analog score. RESULTS： Sixty-two patients were included and all of them entered the result analysis.The preoperative patients in two groups were comparable with each other and the differences of Lysholm score were not significant （t =0.127,P=0.899）.The operative time was longer in synovectomy group than in control group,the differences were significant （t=9.547,P 〈 0.001） and the postoperative draining quantity was more in synovectomy group. The postoperative visual analog score was bigger in synovectomy group than in control group and the differences were significant [the scores of synovectomy and control groups were respectively （4.6 ± 1.1）, （2.8 ± 1.4）, t=6.206,P 〈 0.001].The differences of knee joint score in 1-year follow-up were not significant [the scores of synovectomy and control groups were respectively （77.6±11.9）,（79.0±10.3）,t=0.562,P=0.576]. CONCLUSION： Synovectomy can not increase the curative effect in the near future in the arthroscopic debridement of osteoarthritis.On the contrary,the operative time was longer,the operative wound was larger and postoperative reaction was more serious.lt should not be used in the debridement generally.