关节镜下髌周松解联合髌骨周围去神经化治疗髌股关节炎膝前痛疗效及对软骨退变程度的影响

Efficacy of Arthroscopic Peripatellar Release Combined with Peripatellar Denervation in the Treatment of Anterior Knee Pain in Patellofemoral Arthritis and Its Effect on the Degree of Cartilage Degeneration

目的:研究关节镜下髌周松解联合髌骨周围去神经化治疗髌股关节炎(PFOA)膝前痛疗效及对软骨退变程度的影响。方法:将155例PFOA膝前痛患者采用简单随机分组法为研究组78例和对照组77例,两组患者均采用关节镜下清理术,对照组采用去神经化治疗,研究组采用髌周松解联合髌骨周围去神经化治疗。术后随访6个月。记录并比较两组患者疗效、软骨退变程度、膝关节功能和不良反应。结果:术后,两组术后各时间VAS评分均较术前降低,存在时间、分组和交互效应,且研究组均优于对照组(P<0.05);术后,两组患者Lysholm膝关节功能(LKSS)评分较术前提高、骨性关节炎指数评分(WOMAC)评分较术前明显降低(P<0.05),研究组显著优于对照组,且研究组术前术后上述评分差值均高于对照组(P<0.05);治疗后,两组基质金属蛋白酶-3(MMP-3)表达明显降低,基质金属蛋白酶抑制物-1(TIMP-l)表达明显提高,且研究组明显优于对照组,研究组上述指标术前术后差值均高于对照组(P<0.05);研究组的术后并发症例数稍低于对照组,发生率分别为8.97%与12.98%,无明显差异(P>0.05)。结论:给予PFOA膝前痛患者关节镜下髌周松解联合髌骨周围去神经化治疗能够促使患者早日恢复膝关节运动功能,降低患者的疼痛感,减缓其软骨退变程度,具有临床推广价值。

Objective:To study the efficacy of arthroscopic peripatellar release combined with peripatellar denervation in the treatment of patellofemoral arthritis(PFOA)with anterior knee pain and its effect on the degree of cartilage degeneration.Methods:A total of 155 patients with PFOA and anterior knee pain were divided into study group(78 cases)and control group(77 cases)by the simple random grouping method.Both groups were treated with arthroscopic debridement,the control group with denervation and the study group with peripatellar release combined with peripatellar denervation,and they were followed up for 6 months after surgery.The efficacy,cartilage degeneration degree,knee function and adverse reactions of the two groups were recorded and compared.Results:Postoperatively,VAS scores were lower in both groups at all times compared to preoperatively,with time,group and interaction effects,and the study group was better than the control group(P<0.05);postoperatively,Lysholm knee function(LKSS)scores improved and the scores of Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were significantly lower in both groups compared to preoperatively(P<0.05),and the study group was significantly better than the control group(P<0.05),and the differences of the above scores before and after surgery in study group were higher than those in control group(P<0.05).After treatment,the expression of matrix metalloproteinase-3(MMP-3)was significantly decreased while the expression of tissue inhibitor of metalloproteinase-1(TIMP-1)was significantly increased,and the expressions were significantly better in study group than those in control group,and the differences of the above indicators before and after surgery were higher in study group compared with those in control group(P<0.05).The number of postoperative complications in the study group was slightly lower than that in the control group,with incidence rates of 8.97%and 12.98%respectively,with no significant difference(P>0.05).Conclusion:Arthroscopic peripatellar release combined with peripatellar denervation in patients with PFOA and anterior knee pain can prompt the early recovery of knee motor function,reduce pain and slow down the degree of cartilage degeneration,with clinical promotion value.