关节镜清理与几丁糖治疗中重度膝骨性关节炎

Arthroscopic debridement combined with intraarticular injection of medical chitosan for moderate-severe knee osteoarthritis

[目的]评价膝关节清理术联合医用几丁糖治疗中重度膝骨关节炎的效果。[方法]2014年9月~2019年9月,248例单侧中重度膝骨关节炎患者随机分为两组。其中,手术组127例采用关节镜清理术联合医用几丁糖关节内注射治疗,保守组121例仅采用医用几丁糖关节内注射治疗。比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、膝骨关节炎严重性指数评分(index of severity for osteoarthritis,ISOA)和Lysholm评分。[结果]两组患者均顺利完成治疗。随时间推移,两组患者VAS评分均显著降低(P<0.05);术前两组间VAS评分的差异无统计学意义(P>0.05),治疗后7 d和14 d,手术组的VAS评分显著低于保守组(P<0.05)。所有患者随访48周以上。随时间推移,两组患者ISOA评分显著降低(P<0.05),而治疗前至治疗后12周Lysholm评分显著增加;治疗后24~48周稍有下降,不同时间点间差异有统计学意义(P<0.05)。治疗前两组间ISOA评分和Lysholm评分的差异均无统计学意义(P>0.05),但是,治疗后6、12、12和48周,手术组的ISOA和Lysholm评分均显著优于保守组(P<0.05)。[结论]关节镜下膝关节清理术联合关节腔注射医用几丁糖治疗中重度膝骨关节炎具有较好的中短期疗效。

[Objective]To evaluate the short-term clinical outcomes of arthroscopic debridement combined with medical chitosan injected intraarticularly for treatment of moderate to severe knee osteoarthritis.[Methods]From September 2014 to September 2019,248 patients with unilateral moderate-severe knee osteoarthritis were randomly divided into two groups.Among them,127 patients in the surgical group were treated with arthroscopic debridement combined with intra-articular injection of medical chitosan,while the remaining 121 patients in the conservative group were treated with intraarticular injection of medical chitosan only.The visual analogue scale(VAS)for pain,index of severity for osteoarthritis(ISOA)and Lysholm score were compared between the two groups.[Results]The patient in both groups had treatments completed smoothly.The VAS scores decreased significantly in both groups over time(P<0.05).Although no a statistically significant difference was noticed in VAS scores between the two groups before treatment(P>0.05),the surgical group got significantly lower VAS scores at 7d and 14d after treatment than the conservative group(P<0.05).All patients were followed up for more than 48 weeks.As time went the ISOA score decreased significantly in both groups(P<0.05),while the Lysholm score increased significantly from the time point before treatment to 12 weeks after treatment,and decreased slightly from 24 to 48 weeks after treatment,with statistically significant differences in both groups among different time points(P<0.05).There was no statistically significant difference in ISOA score and Lysholm score between the two groups before treatment(P>0.05),but the surgical group proved significantly superior to the conservative group regarding ISOA and Lysholm scores at 6,12,24 and 48 weeks after treatment(P<0.05).[Conclusion]Arthroscopic debridement combined with intraarticular injection of medical chitosan has good short-term curative effects for treatment of moderate-severe knee osteoarthritis.