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      臨床研究

      膝關節鏡清理術治療膝骨性關節炎的臨床觀察

      王闖

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      【摘要】  【摘要】目的 研究膝骨性關節炎采用膝關節鏡清理術治療的臨床優勢。方法 選擇100例膝骨性關節炎病患,按照治療方式差異均分兩組。對照組應用透明質酸鈉注射保守治療,觀察組應用膝關節鏡清理術治療,比較兩組臨床療效、治療前后不同階段Lysholm評分與VAS評分,統計治療后復發率差異。

      【關鍵字】  膝骨性關節炎,膝關節鏡,Lysholm評分,VAS評分,復發率

      中圖分類號:文獻標識碼:文章編號:

      [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.

      膝骨性關節炎在老年階段較為常見,屬于慢性變性病癥,患者關節軟骨受到損害,關節內積水、膝關節腫脹[1]。由于組織損傷,患者會感到明顯疼痛感,加上膝關節屬于頻繁受力關節處,因此可能存在活動受限、無法正常負重情況,直接影響患者生存質量[2]。若膝骨性關節炎未得到有效控制,在疾病進展下會引起關節中游離態物質增加以及骨質增生,加重運動困難程度[3]。在臨床治療中,若膝骨性關節炎處于早期,可通過保守方式利用鎮痛藥物緩解疼痛,通過外敷貼劑消除炎癥,但在治療效果上缺乏理想性,存在較高復發率[4]。隨著臨床醫療的進步,關節腔內注射透明質酸鈉可有效控制炎癥進展,對軟骨展開修復與保護,提升軟骨內滑液粘彈性,但在療效上尚有提升空間。近年來,關節鏡操作逐漸受到重視,具有診斷準確、恢復快、損傷小的優勢,相對于單純關節內注射方式而言對治療更具徹底性,可有效控制復發率并加速炎癥的恢復[5]。本次研究以對比形式觀察了膝關節鏡清理術在膝骨性關節炎,臨床治療中的應用價值。 1 資料與方法 1.1 一般資料:選取在2016年8月至2018年9月收治的膝骨性關節炎住院病患共100例,按照隨機數字表法均分兩組。對照組中男女比例為28∶22;年齡42~70歲,平均年齡(57.03±4.22)歲;膝骨性關節炎病程在1~7年,平均(3.51±0.69)年;治療前Lysholm評分平均(43.61±5.83)分,VAS評分平均(6.37±0.89)分。觀察組中男女比例為27∶23;年齡43~69歲,平均年齡(58.17±4.53)歲;膝骨性關節炎病程在1~7年,平均(3.63±0.59)年;治療前Lysholm評分平均(43.59±4.86)分,VAS評分平均(6.42±0.71)分。組間基礎資料無明顯差異(P>0.05)。 納入標準:關節鏡分級及Kellgren-Lawrence分級均在2級以上,經我院X線診斷顯示結構異常,膝骨性關節炎處于晚期或進展期,患者膝關節活動時存在不同程度摩擦音,晨僵在30 min內、關節液呈粘稠、清亮狀,站立X線攝片顯示軟骨下骨硬化、關節間隙狹窄、關節緣骨贅,白細胞計數在2000個/mL以內。剔除標準:存在膝關節鏡下手術史、凝血功能障礙、痛風性或風濕性關節炎、膝關節發育畸形、膝關節骨折、膝關節脫位、氟骨性膝痛者。

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