摘要
目的探讨关节镜下清理术联合Ilizarov牵伸术治疗膝关节骨关节炎(knee osteoarthritis,KOA)的近期疗效。方法 2014年1月—2015年1月,采用关节镜下清理术联合Ilizarov牵伸术治疗KOA患者15例(15膝)。其中男7例,女8例;年龄45~64岁,平均55岁。左膝6例,右膝9例。病程2.0~9.5年,中位病程6年。患者均经6个月保守治疗,临床症状无明显改善。术前疼痛视觉模拟评分(VAS)为(76.2±8.8)分,美国西部Ontario与Mc Master大学骨关节炎指数评分(WOMAC)为(59.3±5.7)分,膝关节损伤和骨关节炎评定量表评分(KOOS)为(44.3±7.2)分,膝关节活动度(range of motion,ROM)为(75±21)°。X线片测量关节间隙为(2.5±0.4)mm。根据Kellgren-Lawrence分级标准,Ⅲ级11例、Ⅳ级4例。结果术后切口均Ⅰ期愈合,外固定支架钉道无感染,无下肢深静脉血栓形成等相关并发症发生。患者均获随访,随访时间12~18个月,平均15.5个月。术后患者膝关节疼痛症状及关节活动明显改善,术后12个月VAS评分、WOMAC评分、KOOS评分分别为(20.9±7.8)、(38.2±5.5)、(92.1±6.9)分,膝关节ROM为(118±14)°,均优于术前,比较差异有统计学意义(t=18.213,P=0.000;t=10.317,P=0.000;t=18.564,P=0.000;t=6.599,P=0.000)。X线片复查示,术后12个月关节间隙为(3.8±0.3)mm,与术前比较差异有统计学意义(t=10.070,P=0.000)。结论关节镜下清理术联合Ilizarov牵伸术治疗KOA,可有效缓解关节疼痛,提高膝关节功能,利于软骨组织修复,延缓骨关节炎进展,近期疗效满意。
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis （KOA）. Methods Between January 2014 and January 2015, 15 patients （15 knees） with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years （mean, 55 years）. The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years （median, 6 years）. They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale （VAS） score, the Western Ontario and McMaster University Osteoarthritis Index （WOMAC） score, the knee injury and osteoarthritis outcome score （KOOS）, the range of motion （ROM） for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, （75±21）±, and （2.5±0.4） mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months （mean, 15.5 months）. Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and （118±14）° respectively, showing significant difference when compared with preoperative ones （t=18.213, P=O.O00; t=10.317, P=0.O00; t=18.564, P=0.O00; t=6.599, P=0.O00）. Postoperative X-ray film showed that joint space width at 12 months was （3.8±0.3） mm, showing significant difference when compared with preoperative one （t=10.070, P=0.000）. Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2017年第7期794-798,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81672210)
江苏省"科教强卫工程"专项经费资助(QNRC2016463)~~
