【摘要】：目的探討關(guān)節(jié)鏡下清理術(shù)聯(lián)合Ilizarov牽伸術(shù)治療膝關(guān)節(jié)骨關(guān)節(jié)炎(knee osteoarthritis,KOA)的近期療效。方法 2014年1月—2015年1月,采用關(guān)節(jié)鏡下清理術(shù)聯(lián)合Ilizarov牽伸術(shù)治療KOA患者15例(15膝)。其中男7例,女8例;年齡45~64歲,平均55歲。左膝6例,右膝9例。病程2.0~9.5年,中位病程6年�；颊呔�(jīng)6個(gè)月保守治療,臨床癥狀無明顯改善。術(shù)前疼痛視覺模擬評(píng)分(VAS)為(76.2±8.8)分,美國西部Ontario與Mc Master大學(xué)骨關(guān)節(jié)炎指數(shù)評(píng)分(WOMAC)為(59.3±5.7)分,膝關(guān)節(jié)損傷和骨關(guān)節(jié)炎評(píng)定量表評(píng)分(KOOS)為(44.3±7.2)分,膝關(guān)節(jié)活動(dòng)度(range of motion,ROM)為(75±21)°。X線片測(cè)量關(guān)節(jié)間隙為(2.5±0.4)mm。根據(jù)Kellgren-Lawrence分級(jí)標(biāo)準(zhǔn),Ⅲ級(jí)11例、Ⅳ級(jí)4例。結(jié)果術(shù)后切口均Ⅰ期愈合,外固定支架釘?shù)罒o感染,無下肢深靜脈血栓形成等相關(guān)并發(fā)癥發(fā)生�；颊呔@隨訪,隨訪時(shí)間12~18個(gè)月,平均15.5個(gè)月。術(shù)后患者膝關(guān)節(jié)疼痛癥狀及關(guān)節(jié)活動(dòng)明顯改善,術(shù)后12個(gè)月VAS評(píng)分、WOMAC評(píng)分、KOOS評(píng)分分別為(20.9±7.8)、(38.2±5.5)、(92.1±6.9)分,膝關(guān)節(jié)ROM為(118±14)°,均優(yōu)于術(shù)前,比較差異有統(tǒng)計(jì)學(xué)意義(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線片復(fù)查示,術(shù)后12個(gè)月關(guān)節(jié)間隙為(3.8±0.3)mm,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(t=10.070,P=0.000)。結(jié)論關(guān)節(jié)鏡下清理術(shù)聯(lián)合Ilizarov牽伸術(shù)治療KOA,可有效緩解關(guān)節(jié)疼痛,提高膝關(guān)節(jié)功能,利于軟骨組織修復(fù),延緩骨關(guān)節(jié)炎進(jìn)展,近期療效滿意。
[Abstract]:Objective to investigate the short-term effect of arthroscopic debridement combined with Ilizarov drafting in the treatment of knee osteoarthritis (knee osteoarthritis,KOA). Methods from January 2014 to January 2015, 15 patients (15 knees) with KOA were treated with arthroscopic debridement combined with Ilizarov drafting. There were 7 males and 8 females, aged 45 to 64 years (mean 55 years). There were 6 cases of left knee and 9 cases of right knee. The course of disease ranged from 2.0 to 9.5 years and the median course was 6 years. All the patients were treated conservatively for 6 months and their clinical symptoms were not obviously improved. Preoperative pain visual analogue score (VAS) was (76.2 鹵8.8), Ontario and Mc Master university osteoarthritis index (WOMAC) were (59.3 鹵5.7). The score of knee joint injury and osteoarthritis rating scale (KOOS) was (44.3 鹵7.2), the range of knee motion (range of motion,ROM) was (75 鹵21) 擄, and the joint space was (2.5 鹵0.4) mm. measured by X-ray. According to Kellgren-Lawrence classification standard, 11 cases were grade 鈪，

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