膝关节骨性关节炎关节镜下清理和联合髌外侧减压及康复治疗临床疗效的对比研究

Short-term and Long-term Efficacy of Arthroscopic Debridement,Lateral Patellar Decompression,and Rehabilitation Therapy for Osteoarthritis of the Knee Joint

目的对比研究膝关节骨性关节炎关节镜下清理和联合髌外侧减压及康复治疗的临床效果。方法依据美国风湿学会膝OA诊断标准选择膝骨性关节炎85例。采用抽签分组,A组行单纯关节镜下清理术,共39例;B组行关节镜下清理术+髌外侧减压术,共46例。手术均由同一名医生完成。术后由同一康复组实施康复训练。2组均在术前、术后3个月和术后6个月分别用Lysholm评分表、膝关节百分法评分表及简化McGill疼痛量表PPI评分,以及髌骨倾斜试验、髌骨滑动试验等进行评估。结果A组术后3个月Lysholm评分、膝关节百分法和疼痛量表评分明显优于术前;术后6个月与术后3个月比较无显著性差异。B组术后3个月Lysholm、百分法和疼痛量表评分明显优于术前;术后6个月明显优于术后3个月。术后3个月A组恢复情况优于B组,术后6个月B组Lysholm评分优于A组。结论髌骨活动受限的膝关节骨性关节炎患者关节镜下清理术与术后康复可以改善膝部症状与膝关节功能。关节镜下清理联合髌外侧减压术后早期临床症状改善,随着康复训练的进展,6个月后临床症状、体征、膝部功能明显改善,优于单纯的关节镜下清理术。

Objective To study the short-term efficacy of arthroscopic debridement,lateral patellar decompression,and rehabilitation thearpy for osteoarthritis of the knee joint,and to discuss the long-term outcomes of the treatments.Methods A total of 85 cases of osteoarthritis that were diagnosed according to the clinical diagnostic criteria of ACR were enrolled in this study.The patients were randomly divided into groups A（39 cases） and B（46 cases） to underwent arthroscopic debridement and arthroscopic debridement combined with lateral patellar decompression respectivley.All the operations were performed by a same surgeon.Postoperative rehabilitation thearpies were carried out by one group of therapist.The Lysholm,HSS,and PPI scores were evaluated before the operation,as well as patellar tilt test and patellar gliding test.The examinations were repeated in 3 and 6 months respectivley after the surgery.Results In group A,the scores of Lysholm,HSS,and PPI determined at month 3 were significantly higher than those before the operation,but not changed markedly at month 6.Whereas,in group B,the scores kept being increased after the surgery.At month 3,the scores in group A were higher than those in group B,however,at month 6,the Lysholm score in group B was higher than that in group A.Conclusions Arthroscopic debridement and postoperative rehabilitation are effective for imroving the symtoms and knee function in patients with osteoarthritis and limited ROM of the patella.Combining with lateral patellar decompression,the treatments can achieve better outcomes in 6 months.