关节镜下清理术对膝关节骨性关节病早期及中期疗效分析

Early and med-term outcome analysis of arthroscopic debridement for patients with degenerative knee osteoarthritis

关节镜下膝关节清理术对于退变引起的膝骨关节病的疗效目前仍存在争议,探讨了关节镜下清理术对不同程度膝骨关节病的治疗效果。分析了北京天坛医院骨科2011年9月至2016年9月期间接受关节镜清理术的膝关节病患者,根据Kellgren-Lawrence(K-L)分级进行分组,并进行术后随访。发现与术前相比,4组患者在术后6月、1年的牛津大学膝关节评分(Oxford Knee Score,OKS)、膝关节损伤和骨关节炎评分(Knee Injury and Osteoarthritis Outcome Score,KOOS)及数字疼痛评分均较术前显著改善。术后3年,K-L分级I-II级患者术上述评分仍比术前有所改善,但K-L分级III级患者与术前相比无显著差异,K-L分级Ⅳ级患者的评分比术前差。提示关节镜下膝关节清理术对于膝关节骨性关节病K-L分级I-II级,症状明显且保守治疗失败的患者有良好的术后早期及中期疗效;对III-IV级患者,术后早期疗效较好,但中期效果较差。

The efficacy of the knee arthroscopic debridement for patients with degenerative osteoarthritis of the knee is still a controversial issue. In order to clarify the indications of the knee arthroscopic debridement, the effect of the arthroscopic debridement on the degree of the knee osteoarthritis is studied. A retrospective analysis is made for patients with knee osteoarthritis, after the arthroscopic debridement in the department of orthopedics of Beijing Tiantan Hospital from September2011 to September 2016. According to the Kellgren-Lawrence(K-L) classification, the knee osteoarthritis patients are divided into four groups from degrees I to IV and are followed up after the surgery. It is found that the Oxford Knee Score(OKS), the Knee Injury and Osteoarthritis Outcome Score(KOOS), and the Numeric Pain Rating Scale in the four groups are significantly improved post-operatively after 6 months and 1 year. After 3 years post-operatively, for patients of degrees I and II, the scores are also significantly improved. However, no significant difference is observed for patients of degree III and the scores are even decreased for patients of degree IV after 3 year post-operatively. Our study indicates that the arthroscopic knee arthroplasty has a good effect in the early and middle postoperative period for patients of knee osteoarthritis of K-L degrees I and II. For patients of severe osteoarthritis of K-L degrees III and IV, the clinical symptoms can be partially alleviated in the early stage, but the mid-term efficacy is not satisfactory.