关节镜下半月板切除治疗退行性半月板损伤的临床疗效分析

Arthroscopic partial meniscectomy versus sham Surgery for degenerative meniscal tear

目的 目前临床上关节镜技术已被广泛应用到半月板损伤中,但是对于单纯半月板退行性损伤的疗效是否优于保守治疗尚无研究。方法 收集2012年8月至2015年9月102例35~65岁的内侧半月板退行性损伤而无膝关节骨性炎的膝关节疼痛患者,进行随机对照研究,分为关节镜手术治疗和保守治疗两组,治疗后随访12个月,通过分析Lysholm膝关节功能评分(0~100分,分数越低表示症状越重)、WOMET评分(0~100分,分数越低表示症状越重)、膝关节疼痛程度较治疗前的改善情况来评估两组的治疗效果。结果 治疗后12个月,2种治疗方法均取得一定疗效,在Lysholm膝关节功能评分、WOMET评分、膝关节疼痛程度方面,较治疗前均有明显改善,差异均有统计学意义(均P<0.05);Lysholm膝关节功能评分改善情况:关节镜手术组为21.7分,保守治疗组为23.3分;WOMET评分改善情况:关节镜手术组24.6分,保守治疗组为27.1分;活动后膝关节疼痛评分改善情况:关节镜手术组3.1分,保守治疗组3.3分;12个月后,休息时膝关节疼痛程度评分改善情况:关节镜手术组2.5分,保守治疗组2.5分;两组在各量表改善情况比较,差异均无统计学意义(均P>0.05)。关节镜治疗组中,有2例进行了二次手术,保守治疗组中有5例进行了二次手术。结论 在本实验中,对于患有内侧半月板退行性损伤而不伴有膝关节骨性关节炎的资料中,关节镜下部分半月板切除术的治疗效果并不优于保守治疗;但是从二次手术的角度考虑,关节镜手术治疗有一定的优势。

Objective Current arthroscopy technique has been widely applied to the meniscus injury,but it is absence of the research of whether arthroscopic partial meniscectomy is more effective than symptomatic treatment.Methods We conducted a randomized and controlled trial in 35 to 65 years old 102 patients who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis and who were treated at our hospital from August,2012 to September,2015.The patients were randomly assigned to arthroscopic partial meniscectomy or symptomatic treatment.After 12 months’follow-up,the changes in the Lysholm and WOMET scores(each ranging from 0 to 100;lower scores indicates more severe symptoms)and in knee pain(rated on a scale from 0 to 10;0 denotes no pain)were analyzed.Results After 12 months’treatment,there were some outcomes in the two groups,there was some improvement in Lysholm score,WOMET score,and knee pain score(P<0.05).The mean changes in Lysholm score:the arthroscopic group is 21.7 points,the symptomatic treatment groups is 23.3 points;The mean changes in WOMET score:it was 24.6 points in the arthroscopic group,27.1 points in the symptomatic treatment group.The mean changes in the knee pain score after exercise:it was 3.1 points the arthroscopic group,and 3.3 points the symptomatic treatment group.The mean changes in knee pain score in rest:it was 2.5 points in the arthroscopic group,and 2.5 points in the symptomatic treatment group.There were no statistical differences in the scales between the two groups.There were some patients who required subsequent knee surgery:two in the partial meniscectomy group and five in the symptomatic treatment group.But for subsequent knee surgery,the arthroscopic partial meniscectomy was better than the symptomatic treatment.Conclusions In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear,the outcomes after arthroscopic partial meniscectomy aree no better than those after a sham surgical procedure.