临床研究

膝关节镜清理术治疗膝骨性关节炎的临床观察

王闯

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【摘要】  【摘要】目的 研究膝骨性关节炎采用膝关节镜清理术治疗的临床优势。方法 选择100例膝骨性关节炎病患,按照治疗方式差异均分两组。对照组应用透明质酸钠注射保守治疗,观察组应用膝关节镜清理术治疗,比较两组临床疗效、治疗前后不同阶段Lysholm评分与VAS评分,统计治疗后复发率差异。

【关键字】  膝骨性关节炎,膝关节镜,Lysholm评分,VAS评分,复发率

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[Abstract] Objective To study the clinical advantages of knee arthroscopic debridement for knee osteoarthritis. Methods 100 patients with knee osteoarthritis were divided into two groups according to the difference of treatment methods. The control group was treated with sodium hyaluronate injection and the observation group was treated with knee arthroscopic debridement. The clinical efficacy, Lysholm score and VAS score at different stages before and after treatment were compared between the two groups. The recurrence rate after treatment was statistically different. Results The total effective rate was 84.00% in the control group and 98.00% in the observation group. The Lysholm score of the control group was (59.31±3.25) and (74.92±3.88) at 3 months and 6 months after treatment, and the VAS score was (4.55±0.64) and (3.17±0.58) respectively. The Lysholm score of the observation group was (85.44±3.62) and (91.07±3.24) at 3 months and 6 months after treatment, and the VAS score was (3.03±0.29) and (0.93±0.16) respectively. The recurrence rate was 16% in the control group and 2% in the observation group. Conclusion Compared with conservative treatment, knee arthroscopic debridement can improve knee function of knee osteoarthritis patients more obviously. It can reduce the degree of pain caused by inflammation as early as possible and control the recurrence rate of inflammation.

膝骨性关节炎在老年阶段较为常见,属于慢性变性病症,患者关节软骨受到损害,关节内积水、膝关节肿胀[1]。由于组织损伤,患者会感到明显疼痛感,加上膝关节属于频繁受力关节处,因此可能存在活动受限、无法正常负重情况,直接影响患者生存质量[2]。若膝骨性关节炎未得到有效控制,在疾病进展下会引起关节中游离态物质增加以及骨质增生,加重运动困难程度[3]。在临床治疗中,若膝骨性关节炎处于早期,可通过保守方式利用镇痛药物缓解疼痛,通过外敷贴剂消除炎症,但在治疗效果上缺乏理想性,存在较高复发率[4]。随着临床医疗的进步,关节腔内注射透明质酸钠可有效控制炎症进展,对软骨展开修复与保护,提升软骨内滑液粘弹性,但在疗效上尚有提升空间。近年来,关节镜操作逐渐受到重视,具有诊断准确、恢复快、损伤小的优势,相对于单纯关节内注射方式而言对治疗更具彻底性,可有效控制复发率并加速炎症的恢复[5]。本次研究以对比形式观察了膝关节镜清理术在膝骨性关节炎,临床治疗中的应用价值。 1 资料与方法 1.1 一般资料:选取在2016年8月至2018年9月收治的膝骨性关节炎住院病患共100例,按照随机数字表法均分两组。对照组中男女比例为28∶22;年龄42~70岁,平均年龄(57.03±4.22)岁;膝骨性关节炎病程在1~7年,平均(3.51±0.69)年;治疗前Lysholm评分平均(43.61±5.83)分,VAS评分平均(6.37±0.89)分。观察组中男女比例为27∶23;年龄43~69岁,平均年龄(58.17±4.53)岁;膝骨性关节炎病程在1~7年,平均(3.63±0.59)年;治疗前Lysholm评分平均(43.59±4.86)分,VAS评分平均(6.42±0.71)分。组间基础资料无明显差异(P>0.05)。 纳入标准:关节镜分级及Kellgren-Lawrence分级均在2级以上,经我院X线诊断显示结构异常,膝骨性关节炎处于晚期或进展期,患者膝关节活动时存在不同程度摩擦音,晨僵在30 min内、关节液呈粘稠、清亮状,站立X线摄片显示软骨下骨硬化、关节间隙狭窄、关节缘骨赘,白细胞计数在2000个/mL以内。剔除标准:存在膝关节镜下手术史、凝血功能障碍、痛风性或风湿性关节炎、膝关节发育畸形、膝关节骨折、膝关节脱位、氟骨性膝痛者。

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