关节镜下清理与钻孔减压术治疗膝关节骨性关节炎

Arthroscopic debridement and drilling decompression in the treatment of knee osteoarthritis

[目的]观察关节镜下清理结合钻孔减压术治疗膝关节骨性关节炎的临床疗效。[方法]选择2000年1月~2008年12月136例（155膝）膝关节骨性关节炎患者,回顾性观察进行膝关节镜下清理术（A组）、钻孔减压术（B组）、膝关节镜下清理结合钻孔减压术（C组）和保守治疗组（D组）四种方法治疗的疗效。术后随访3个月~1年,采用形象类比评分（visual analogue scale,VAS）评价手术前后的活动痛和休息痛的程度,采用HSS膝关节评分对行走功能进行比较。[结果]3个月内,A组和C组的活动性疼痛改善均明显优于D组（P〈0.05）;B组和C组的休息疼痛改善均明显优于D组（P〈0.05）;A、B、C组三组的行走功能改善均明显优于D组（P〈0.05）。6个月内,C组的活动性疼痛改善明显优于D组（P〈0.05）;B组和C组的休息疼痛改善均明显优于D组（P〈0.05）;而C组的行走功能改善明显优于D组（P〈0.05）。1年以上随访,各组休息痛、静息痛和行走功能无明显差别（P〉0.05）。[结论]膝关节镜下清理术和钻孔减压术是治疗膝关节骨性关节炎较为理想的方法,应用钻孔减压术在治疗休息痛方面有比较明显的疗效,而关节镜下清理术在治疗活动性疼痛方面有优势,结合此两种手术,可取得比较明显的治疗效果,但长期随访中显示此两种手术并不能完全阻止骨性关节炎的进展。

[Objective]To observe the clinical effects of arthroscopic debridement versus drilling decompression in the treatment of knee osteoarthritis. [Methods]One hundred and thirty six patients with osteoarthritis treated in our hospital from 2000 to 2008 were selected.These patients were divided into 4 groups（group A received arthroscopic debridement,group B received drilling decompression,group C received arthroscopic debridement plus drilling decompression,group D received conservative treatment）.The follow up period was 3 months to 1 years.Pain motion and pain rest were measured preoperatively and postoperatively using visual analogue scale.However,the walking function was assessed using hospital for special surgery knee score.[Results]During the first 3 months,both of groups A and C were superior to group D in pain motion relief（P0.05）.Groups B and C were better than group D in pain rest relief（P0.05）.Groups A,B and C had advantages over group D in improving walking function.Within 6 months,groups C was superior to group D in pain motion relief（P0.05）.Both of groups B and C were better than group D in pain rest relief（P0.05）.Groups A,B and C had advantages over group D in improving walking function.However,there were no obvious differences in pain motion,pain rest and walking function among groups（P0.05）in one year＇s follow up.[Conclusion]Arthroscopic debridement plus drilling decompression is an ideal treatment for knee osteoarthritis.Drilling decompression has excellent effects in the treatment of pain rest,yet arthroscopic debridement has advantages in treatment of pain motion.However,neither arthroscopic debridement nor drilling decompression is able to prevent the development of knee osteoarthritis.