关节置换与关节镜清理联合玻璃酸钠注射治疗膝骨性关节炎

Effectiveness comparison between knee replacement and arthroscopic debridement combined sodium hyaluronate injection for knee osteoarthritis

背景：膝骨性关节炎的保守治疗为关节腔注射玻璃酸钠;手术治疗主要有关节镜清理、人工膝关节置换。目前关于骨关节炎治疗的研究多为各种单独治疗的疗效比较,而关于综合治疗的疗效尚少见。目的：观察膝关节置换与关节镜清理结合关节腔注射玻璃酸钠治疗膝骨性关节炎的效果。方法：选择符合膝骨性关节炎诊断标准的患者55例,年龄50-83岁。根据患者病情告知患者各种治疗的优缺点,由患者考虑后选择治疗方式。其中联合组23例,置换组32例。联合组采用关节镜清理联合关节腔注射玻璃酸钠治疗,1次/周,连续5周;置换组采用膝关节置换治疗。随访6-30个月,治疗前后均采用HSS膝关节评分评价膝骨性关节炎治疗效果。结果与结论：两组疗效综合评估,联合组优8例,良8例,优良率70%;置换组优23例,良7例,优良率94%。两组膝关节的活动度、疼痛、关节功能都有明显改善,但膝关节置换的疗效优于关节镜清理结合关节腔注射玻璃酸钠治疗（P〈0.05）。

BACKGROUND：Treatments for knee osteoarthritis（KOA）contain injecting sodium hyaluronate into the intra-articular or surgical arthroscopic debridement and artificial knee replacement.At present,most study concerning the treatment of osteoarthritis concentrates on effectiveness comparison between various individual therapies,which are few in combined therapy. OBJECTIVE：To investigate the efficacy of treating KOA using knee replacement and arthroscopic debridement with intra-articular injection of sodium hyaluronate. METHODS：Fifty-five KOA patients were collected,aged 50-83 years.The surgical methods were decided by patients following telling the advantages and disadvantages of each treatment.Patients in the joint group（n=23）were treated by arthroscopic debridement and intra-articular injection of sodium hyaluronate,once a week,for 5 successive weeks;those in the replacement group（n=32）received total knee replacement.All patients were followed-up for 6-30 months.The effectiveness of KOA treatment was evaluated by HSS knee scores prior to and after operation. RESULTS AND CONCLUSION：The comprehensive assessment showed,in the joint group,there were 8 excellent cases and 8 good cases with 70 % good rate;in the replacement group,there were 23 excellent cases and 7 good cases,with 94 % good rate.The therapeutic effect of the replacement group was superior to the joint group（P〈0.05）.The knee joint activity,pain,and joint functions were improved significantly after operation,in particular in the replacement group.