关节清理术.pptVIP

关节清理术 罗泽宇 四川大学华西医院骨科 背景 原理：膝OA磨损产生疼痛 2 KOA 滑膜增生 软骨剥脱 软骨不平 半月板磨损 韧带受损 背景 关节镜手术 对韧带损伤或半月板修复效果明显，但是对OA患者的疗效不确切 关节镜下 冲洗、去除或修复软组织 关节冲洗 关节镜冲洗 关节置管冲洗 3 1.Chang, R.W.arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum, 1993. 到底是关节镜的修复作用还是冲洗可以膝OA缓解疼痛 文献 1 4 Design：RCT – 前瞻性随机双盲对照研究 Evidence: Level I – 一级循证医学证据 1.Moseley. N Engl J Med, 2002 Inclusion criteria 75 years old or younger KOA defined by the American College of Rheumatology Pain：4 on VAS No arthroscopy of the knee during the previous two years Exclusion criteria severity grade of 9 or higher (similar to Kellgren-Lawrence classification) severe deformity serious medical problems  Materials Methods Randomization Process stratified sampling Grade 1, 2, or 3; grade 4, 5, or 6; and grade 7 or 8 Treatment Groups Arthroscopic débridement (59) lavaged with 10 liters of fluid rough articular cartilage was shaved chondroplasty was performed loose debris was removed meniscal fragments were trimmed bone spurs were not removed (except tibial spine area) Arthroscopic lavage alone (61) lavaged with at least 10 liters of fluid The placebo (60) three 1-cm incisions were made in the skin a standard arthroscopic débridement procedure was simulated  Materials Methods Follow-up 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months, and 24 months primary end point Pain Knee Specific Pain Scale (KSPS) created for this study Arthritis Impact Measurement Scales (AIMS2-P) 36-item Short-Form Function Arthritis Impact Measurement Scales (AIMS2-WB) 36-item Short-Form Physical Functioning Scale (PFS) (30m and a flight of stairs )  Materials Methods Results Primary outcome (Pain) At no point did either arthroscopic-interventiongroup have greater pain relief than the placebo group   Results Primary outcome (Function) at no time point did either arthroscopic-intervention group have significantly greater improvement in functi