关节镜与开放手术治疗不同Wiberg分型髌股关节骨性关节炎的效果比较

Comparison of effects of arthroscopic versus open surgery on patellofemoral osteoarthritis of different Wiberg types

目的比较关节镜与开放手术治疗不同Wiberg分型髌股关节骨性关节炎的临床效果。方法抽取济源市卫生学校附属医院2017年2月至2019年2月收治的需要手术治疗的髌股关节骨性关节炎患者76例。根据手术治疗方案将纳入患者分为关节镜组(37例)和开放治疗组(39例)。比较关节镜组与开放治疗组患者的手术指标,术前及术后6个月的髌骨关节评分、膝关节评分、疼痛程度评分。结果与开放手术组比较,关节镜组Ⅰ、Ⅱ级手术指标较优,Ⅲ级手术指标较差(P<0.05);术后6个月,关节镜组Ⅰ级和Ⅱ级Kujala、Lysholm评分升高,Ⅲ级Kujala、Lysholm评分降低;术后6个月,关节镜组Ⅰ级和Ⅱ级视觉模拟评分法(VAS)评分降低,Ⅲ级VAS评分升高(P<0.05)。结论关节镜治疗Ⅰ、Ⅱ级分型髌股关节骨性关节炎效果较好,可明显改善髌股关节和膝关节功能,降低疼痛程度,但开放手术对Ⅲ级分型髌股关节骨性关节炎患者的治疗效果更好。

Objective To compare the effects of arthroscopic versus open surgery in the treatment of patellofemoral osteoarthritis of different Wiberg types.Methods A total of 66 patients with patellofemoral osteoarthritis requiring surgical treatment in the Affiliated Hospital of Jiyuan Health School from February 2017 to February 2019 were enrolled.According to the surgical treatment plans,they were divided into arthroscopy group(n=37)and open surgery group(n=39).The operation indexes,patellar joint score,knee joint score and pain score before and 6 months after operation were compared between arthroscopy group and open treatment group.Results Compared with the open surgery group,the arthroscopy group had better grade I and grade II surgical indicators,and the grade III surgical indicators were worse(P<0.05).Kujala and Lysholm scores of grade I and II increased,while those of grade III decreased 6 months after operation(P<0.05).The visual analogue scale(VAS)scores of grade I and II in arthroscopy group decreased,while VAS score of grade III increased 6 months of treatment(P<0.05).Conclusions Arthroscopy in grade I and II patellofemoral osteoarthritis has good efficacy and surgical indicators,which significantly improved patellofemoral joint and knee joint function,and reduced pain.However,open surgery is better for patients with grade III patellofemoral osteoarthritis.