关节间隙对关节镜治疗膝骨关节炎疗效影响的研究

Study on the effect of joint space on the curative effect of arthroscopic treatment of knee osteoarthritis

目的研究关节间隙对关节镜技术治疗膝关节骨性关节炎疗效的影响。方法回顾性分析2015年1月至2019年10月在解放军联勤保障部队第九六八医院骨科行关节镜清理术的膝关节骨性关节炎223例患者的临床资料和随访数据,根据磁共振测量关节间隙最窄处的数值,将患者分为3组:关节间隙3 mm以下为A组,关节间隙3~4 mm为B组,关节间隙4 mm以上为C组,并通过术后回访测评(WOMAC评分、GROC评分)评价膝关节间隙、年龄等因素对于关节镜清理术效果的影响。结果3组患者在年龄、肌酐、尿酸等基础资料方面差异无统计学意义(P>0.05)。关节镜清理术后随访1年,A组WOMAC评分术前为(99.9±6.3)分,术后为(100.7±2.7)分,差异无统计学意义(P>0.05);B组WOMAC评分术前为(99.6±5.4),术后为(50.8±5.0)分,术后效果优于术前,差异具有统计学意义(P<0.01);C组WOMAC评分术前为(83.7±7.4)分,术后为(40.8±4.2)分,术后效果优于术前,差异具有统计学意义(P<0.01)。术后1年组间比较,B组、C组术后效果均优于A组(P<0.01)。通过Logistic相关回归分析,关节间隙能够影响关节镜手术效果(P<0.01),而年龄等其他因素对于关节镜手术效果的相关性不明显(P>0.05)。使用ROC曲线分析关节间隙发现,关节间隙2.7 mm是预后的分界点,即2.7 mm以上的关节间隙提示关节镜清理术后的病情改善更为明显(即GROC大于或等于3分)。结论关节镜治疗膝骨性关节炎有效,关节间隙<2.7 mm的患者进行关节镜清理术的远期效果欠佳,可考虑其他手术治疗方式。

Objective To explore thejoint space affecting the efficacy of arthroscopy in the treatment of knee osteoarthritis.Methods The clinical data and follow-up data of patients who received arthroscopic debridement were retrospectively analyzed.According to the value of the narrowest joint space measured by magnetic resonance imaging,the patients were divided into three groups.The joint space of less than 3 mm was group A,the joint space of 3 mm-4 mm was group B,and the joint space of more than 4 mm was group C.Postoperative follow-up evaluation was conducted to evaluate the influence of knee joint space,age and other factors on the effect of arthroscopic debridement.Results By analyzing and comparing the basic data of the patients,there was no difference in the basic data such as age,creatinine,and uric acid among the three groups(P>0.05).The WOMAC score of group A was(99.9±6.3)before operation and(100.7±2.7)after operation.There was no significant difference between them(P>0.05).Group B was(99.6±5.4)before operation and(50.8±5.0)after operation.The postoperative effect was better than that before operation,and the difference was statistically significant(P<0.01);Group C was(83.7±7.4)before operation and(40.8±4.2)after operation.The postoperative effect was preferable to that before operation.The difference was statistically significant(P<0.01).One year after operation,the postoperative effects of group B and group C were better than those of group A(P<0.01).Through Logistic regression analysis,joint space can affect the effect of arthroscopic surgery,while other factors such as age have no significant correlation with the effect of arthroscopic surgery.Using ROC to analyze the joint space,it is found that the joint space of 2.7 mm is the cut-off point for prognosis,that is,2.7 mm.A joint space greater than 2.7 mm indicates a more pronounced improvement after arthroscopic debridement.Conclusion Arthroscopic treatment of knee osteoarthritis is effective,and the long-term effect of arthroscopic debridement is poor in patients with joint space less than 2.7 mm,and other surgical treatment methods can be considered for such patients.