全膝关节置换术与关节腔镜微创清除术治疗老年膝骨关节炎的效果比较

Comparison of total knee arthroplasty and arthroscopic minimally invasive debridement in the treatment of senile knee osteoarthritis

目的探究全膝关节置换术(TKA)与关节腔镜微创清除术治疗老年膝骨关节炎的临床疗效。方法选取2018年3月至2023年3月在中山大学附属第五医院接受手术治疗的110例老年膝关节炎患者作为观察对象,按随机抽签法将患者分为对照组和研究组,各55例,对照组患者采取关节镜微创清理术治疗,研究组患者采取TKA治疗,比较两组患者手术治疗优良率及手术前后关节疼痛程度、骨关节炎指数、膝关节功能障碍、生活质量改善情况。结果术后6个月,研究组患者手术治疗优良率高于对照组患者,差异有统计学意义(P<0.05);研究组患者术后6个月时的关节疼痛觉模拟评分法(VAS)、西安大略和麦克马斯特大学骨关节炎指数可视化量表(WOMAC)指数评分低于对照组患者,美国特种外科医院膝关节评分表(HSS)及关节炎影响指数量表(AIMS)评分高于对照组患者,差异有统计学意义(P<0.05);研究组患者术后3个月时的膝关节主动屈曲角测量值大于对照组患者,内翻角测量值小于对照组患者,差异具有统计学意义(P<0.05)。结论TKA治疗老年膝骨关节炎疗效确切,在改善患者膝关节功能、改善运动学参数、减轻关节疼痛程度及骨关节炎指数方面优势显著,能够有效减轻疾病对患者生活质量的影响,具有较高的临床推广应用价值。

Objective To explore the clinical efficacy of total knee arthroplasty(TKA)and arthroscopic minimally invasive debridement in the treatment of senile knee osteoarthritis.Methods A total of 110 elderly patients with knee arthritis who underwent surgical treatment in the Fifth Affiliated Hospital of Sun Yat-sen University from March 2018 to March 2023 were selected as the observation objects,and divided into control group and study group according to the lottery method,with 55 patients in each group.The control group were treated with arthroscopic minimally invasive debridement,while the study group were treated with TKA.The excellent and good rate of surgical treatment,the degree of joint pain before and after operation,osteoarthritis index,knee joint dysfunction and improvement of quality of life were compared between the two groups.Results Six months after operation,the excellent and good rate of surgical treatment in the study group was higher than that in the control group,with statistical significance(P<0.05).The visual analogue scale(VAS)score and the Western Ontario and McMaster Universities(WOMAC)of the patients in the study group were lower than those in the control group at 6 months after operation,the scores of Hospital for Special Surgary(HSS)and arthritis impact measurement scale(AIMS)were higher than those in the control group,and the difference were statistically significant(P<0.05).Three months after operation,the active flexion angle of knee joint in the study group was higher than that in the control group,and the varus angle was lower than that in the control group,with statistical significances(P<0.05).Conclusion TKA is effective in the treatment of knee osteoarthritis in the elderly,which has obvious advantages in improving knee joint function,improving kinematics parameters,reducing joint pain and osteoarthritis index,effectively reducing the impact of diseases on patients'quality of life,and has high clinical application value.