膝骨关节炎的关节镜手术治疗

目的：探讨膝骨关节炎的关节镜手术疗效。方法；78例膝骨关节炎分为保守治疗组和关节镜手术组。分别进行膝关节综合评分，并比较疗效对比分析。结果：保守治疗组膝关节综合评分：优19例，良11例，可8例，差4例；关节镜手术组膝关节综合评分：优21例，良10例，可5例，差0例，疗效明显优越(P＜0．01)。结论：关节镜的使用为治疗膝骨关节炎提供了一种创伤小、疗效好的方法。     

关节镜与玻璃酸钠联合治疗膝骨关节炎121例分析

目的：探讨关节镜与玻璃酸钠联合治疗膝关节骨关节炎的效果。方法：回顾性分析膝骨关节炎121例,均进行膝关节镜下清理术,术后关节腔内注射玻璃酸钠,观察治疗前后患者的疼痛、膝关节活动情况。结果：89例患者获得随访,随访时间6~36个月,平均15.4个月。膝关节功能用Lysholm评分,术后优良率87.6%,随访1 a优良率78.7%,2 a及以后优良率61.8%。结论：膝关节镜清理术联合关节腔内注射玻璃酸钠是治疗膝关节骨关节炎较为理想的方法。     

关节镜下膝骨性关节炎手术要素分析

从2002-01～2003-01我们共进行关节镜下膝关节清理术40例,随访6～12个月,现总结如下.     

关节镜下清创术治疗膝关节骨关节炎

目的:探讨关节镜下清创术治疗膝关节骨关节炎的效果及诊断价值。方法:应用关节镜下清创术治疗膝关节骨关节炎患者86例(92膝)随访6个月~5年。结果:关节镜检查符合率为55.6%。术后疼痛明显减轻,2周后下床活动,随访1~2年优良率93.5%,2年以上优良率83%。结论:关节镜下清创术治疗膝关节骨关节炎可有效缓解疼痛,早期恢复关节功能,延迟骨关节炎的病程,提高诊断准确性。     

关节镜下膝骨性关节炎60例分析

对我院关节镜下膝骨性关节炎60例分析如下。 1临床资料 1．1一般资料本组60例（72膝），男39膝，女33膝，年龄33～79（平均56．7）岁。其中左膝40例，右膝27例，双膝5例。1．2临床表现膝关节反复疼痛肿胀、压痛，关节摩擦感，活动受限；服用消炎止痛药物，关节内封闭等治疗，症状缓解不明显，病史4个月至几年。临床X线片示关节间隙变窄，骨质疏松，非负重面骨赘形成，关节内钙化阴影，关节内游离体等。     

关节镜下关节清理术治疗膝骨关节炎

目的：探讨关节镜下清理术治疗膝骨关节炎的疗效。方法：自1999年3月-2002年6月采关节镜下清理术治疗膝关节骨关节炎患者125例(170膝)。结果：平均随访25个月(6—48个月)，优良率为78．2％。结论：关节镜对于膝骨关节炎可做出明确诊断并确定病变程度，应根据术前临床表现有针对性的进行操作，关节镜下清理术对治疗骨关节炎具有肯定的疗效。     

关节镜下软骨下骨网状钻孔治疗膝关节骨关节炎软骨退变

目的 :探讨关节镜下软骨下骨网状钻孔对膝关节骨关节炎软骨退变的疗效。方法 :对 32例 ( 4 8膝 )膝关节骨关节炎软骨退变患者采用关节镜下软骨下骨网状钻孔 ,以使关节表面形成薄纤维软骨层修复关节软骨。结果 :术后患者症状缓解优良率达 81 2 5 % ,效果满意。结论 :该术式具有手术简便 ,创伤小 ,恢复快 ,并发症少和必要时可重复等优点 ,且可在行关节软骨修复的同时行关节清理术 ,是治疗膝骨关节炎的一种有效手段     

膝骨关节炎的关节镜治疗

我科于 1994年 6月～ 1999年 1月 ,采用关节镜治疗骨关节炎病人共 6 2例 (71膝 ) ,随访 1.5年 ,现报告如下。1　临床资料和方法1.1　一般资料本组共 6 2例 (71膝 ) ,男 13例 ,女 4 9例 ,年龄34～ 71岁 ,平均年龄 57.4岁。左膝 2 8例 ,右膝 2 5例 ,双膝 9例。术前全部病例均有膝关节反复疼痛、肿胀、晨僵。其中活动受限 16例 (18膝 ) ;膝内翻畸形 5例 (6膝 ) ;有关节交锁症状 5例 (5膝 ) ;有跛行、上下楼及下蹲困难 6例 (7膝 )。上述病例均曾使用非甾体类消炎止痛药物及物理治疗 ,疗效不稳定。病史最长 2 0年 ,最短 9个月。1.2　Ｘ线检查根据…     

骨关节炎患者关节镜下滑膜刨削术后膝关节功能1年随访

背景:关节镜下清理术作为一种微创、可重复的治疗骨关节炎的作用已得到众多学者的肯定。但作为关节镜清理术标准步骤之一的滑膜刨削术,其作用近来遭到质疑。目的:探讨骨关节炎关节镜下关节清理术中滑膜刨削术的应用价值。设计:回顾性对照分析。单位:抚顺市中心医院骨科。对象:于1997-02/2000-12抚顺市中心医院骨科行膝关节骨关节炎关节镜下清理术时行滑膜刨削术65例,资料完整并且随访1年以上的患者32例,为滑膜刨削术组;2001-01/2003-11抚顺市中心医院骨科行膝关节骨关节炎关节镜下清理时未行滑膜刨削术48例,资料完整并且随访1年以上的患者30例,为对照组。方法:手术以滑膜刨削术作为干预因素进行分组,采用关节冲洗,游离体摘除,骨赘清除,半月板修整,软骨刨削,滑膜刨削术与不进行滑膜刨削术或局部滑膜刨削术对照行疗效分析。两组病例膝关节功能采用Lysholm膝关节骨关节炎评定标准于术前及术后1年进行评定,并记录手术时间,术后引流量,术后7d视觉模拟评分,术后1年膝关节Lysholm评分。主要观察指标:术前及术后1年膝关节Lysholm评分,手术时间,术后引流量,术后7d视觉模拟评分。结果:纳入患者62例,均进入结果分析。术前两组病例具可比性,Lysholm评分比较差异无显著性(t=0.127,P=0.899)。滑膜刨削术组的手术时间比对照组长,差异显著(t=9.547,P<0.001),术后引流量多。术后视觉模拟评分大于对照组,差异显著[滑膜刨削术组、对照组分别为(4.6±1.1),(2.8±1.4)分,t=6.206,P<0.001],随访1年膝关节评分比较差异无显著性[滑膜刨削术组、对照组分别为(77.6±11.9),(79.0±10.3)分,t=0.562,P=0.576]。结论:滑膜刨削术不能增加膝骨关节炎关节镜下清理术的近期疗效,相反其施术时间长,手术创伤大,术后反应重,不应在关节清理术中常规使用。     

膝前痛的关节镜下病因分析及诊断

目的 采用膝关节镜检术结合临床资料探讨引起膝前痛的关节内致病因素.方法 对该院自2000～2004年就诊的怀疑关节内因素导致的膝前痛病人120例,全部进行膝关节镜探查手术.结果 结合术中镜下及术后病理结果证实髌骨软骨软化症42例、髌股关节炎22例、髌股排列紊乱症21例、滑膜皱襞综合征15例;关节慢性非感染性炎症性疾病10例、髌前脂肪垫综合征7例、股骨髁间凹狭窄症3例.结论 利用膝关节镜技术并结合临床资料、影像学检查可对膝前痛的关节内因素进行病因分析及明确诊断,具有微创、高效、有限治疗等特点,是一种值得推荐的好方法.     

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUNDArthroscopic debridement is a mature treatment for knee osteoarthritis (KOA). Due to the differences in the research subjects, methods, and efficacy evaluation indexes, there are great differences in the surgical efficacy reported in the literature.AIMTo compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODSPatients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group, and those who refused surgical treatment were included in a conservative treatment group. Gender, age, body mass index (BMI), side of KOA, American hospital for special surgery knee score (HSS score) before treatment, visual analogue scale (VAS) score during walking and rest before treatment, conservative treatment content, and surgical procedure were recorded. Outpatient visits were conducted at the 1^st, 3^rd, 6^th, 12^th, and 24^th mo after treatment in the two groups. The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed, and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTSIn the conservative treatment group, there were 80 patients with complete follow-up data, including 20 males and 60 females, aged 58.75 ± 14.66 years old. And in the knee arthroscopic debridement group, there were 98 patients with complete follow-up data, including 24 males and 74 females, aged 59.27 ± 14.48 years old. There was no statistically significant difference in the general data (gender, age, BMI, side of KOA, Kellgren-Lawrence grade distribution, HSS score, and VAS score) between the two groups before treatment. The HSS scores of the conservative treatment group at the 1^st, 3^rd, 6^th, 12^th, and 24^th mo after treatment were significantly higher than that before treatment (P < 0.05). There was no statistical difference in HSS score of the conservative treatment group among the 1^st, 3^rd, 6^th, 12^th, and 24^th mo (P > 0.05). The HSS score of the knee arthroscopic debridement group at the 1^st mo after surgery was significantly higher than that before surgery (P < 0.05). HSS scores of the knee arthroscopic debridement group at the 3^rd, 6^th, 12^th, and 24^th mo were significantly higher than those before surgery and at the 1^st mo after surgery (P < 0.05). There were no statistically significant differences in HSS scores at the 3^rd, 6^th, 12^th, and 24^th mo after surgery (P > 0.05). HSS scores at the 3^rd, 6^th, 12^th, and 24^th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group (P < 0.05). There was no statistical difference in HSS scores between the two groups before treatment and at the 1^st mo of follow-up (P > 0.05). VAS scores during walking and rest were significantly decreased in both groups, and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group, but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSIONCompared with conservative treatment, arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.     

膝关节骨性关节炎肌力训练疗效的临床研究

目的观察以股四头肌及腘绳肌肌力训练疗法为主的综合康复方法治疗膝关节骨关节炎的疗效。方法将我院60例膝关节骨关节炎者随机分为治疗组和对照组各30例。对照组采用超短波、超声中频治疗,治疗组在以上治疗基础上增加股四头肌及腘绳肌肌力训练疗法。结果两组患者经治疗后,视觉模拟评分法(治疗组2.10±0.95,对照组4.18±1.05)和美国Lysholm外科学全膝关节评分法(治疗组85.50±13.52,对照组73.40±12.80)。总分级间差异有统计学意义(治疗组优良率83.3%,对照组优良率50.0%,P<0.05),治疗组的临床疗效明显优于对比组(P<0.01)。结论以股四头肌及腘绳肌肌力训练为主的康复治疗对膝关节骨关节炎具有显著疗效。     

膝关节骨关节炎患者的本体感觉及其与疼痛和功能障碍间的相关性研究

目的明确膝关节骨关节炎（OA）患者膝关节本体感觉误差的程度和分布，并且评价膝关节本体感觉与膝OA患者疼痛和功能障碍之间的关系。方法在Biodex等速系统上用复位测试法测试28例膝OA患者（其中女19例、男9例）和27名同年龄正常人（其中女20例、男7例）的膝关节本体感觉。OA患者疼痛和功能障碍的评定采用目测类比评分法（VAS）和Lequesne指数。结果膝OA患者产生的本体感觉误差比正常人增加了79％（P〈0．05），并以伸膝位的差异百分率最大。在膝关节本体感觉误差和功能障碍之间存在中度的相关关系（r：0．55，P〈0．05），在膝痛和本体感觉误差之间没有显著相关性。结论膝OA患者本体感觉受损，改善其本体感觉可能使患者的功能障碍得到改善，这对膝OA患者的功能评价和康复方案的设计具有重要意义。     

关节镜下清理及术后持续灌洗治疗早期化脓性膝关节炎

目的 探讨关节镜下清理及术后持续灌洗对早期化脓性膝关节炎治疗作用。方法采用关节镜行关节灌洗清理术、持续冲洗引流等综合治疗膝关节化脓性膝关节炎38例,同时结合全身抗生素的应用和术后系统的康复训练进行综合治疗。通过体温、皮温、关节活动度来评价该方法的疗效。结果38例均获随访,时间为12～20个月。体温4d内恢复正常,术后7周,无伸膝功能障碍,屈膝活动度超过120°。关节功能按Neer评分：优26例,良9例,可3例,优良率达到88．89％,无复发。结论关节镜下膝关节清理加置管持续冲洗术是治疗早期化脓性膝关节炎的有效方法,具有损伤小,恢复快,膝关节功能恢复好的优点。     

不同HSS评分的K—L各期膝关节炎患者采用关节镜下清理联合康复治疗的疗效评价

【目的】探讨不同美国特种外科医院膝关节功能评分（HSS）及Kellgren—Lawrance（K—L）分级患者采用关节镜治疗及术后康复治疗的疗效差异,明确关节镜及康复治疗对膝关节骨性关节炎的治疗有效范围。【方法】回顾性分析2010年至2013年在本院实施关节镜清创及术后康复治疗的120例（126膝）患者的临床资料,根据膝关节HSS评分及K-L分级进行分组,对治疗前后不同分级标准下患者膝关节功能评分变化情况进行比较分析。【结果】术前HSS〉70分的K—L分级Ⅰ级、Ⅱ级、Ⅲ级患者的治疗后HSS评分较治疗前均显著的提高（P〈0．05）,K—L分级Ⅰ级、Ⅱ级、Ⅲ级三组患者的HSS评分提高率差异无显著性（P〉0．05）。术前60-69分的K—L分级Ⅰ级、Ⅱ级、Ⅲ级患者的治疗后HSS评分较治疗前均显著的提高（P〈0．05）,K—L分级Ⅰ级、Ⅱ级、Ⅲ级三组患者的HSS评分提高率差异无显著性（P〉0．05）。术前〈60分的K—L分级为Ⅱ级的患者的治疗后HSS评分较治疗前显著的提高（P〈0．05）,K—L分级Ⅲ级、Ⅳ级患者治疗后HSS评分较治疗前差异无显著性（P〉0．05）;治疗后HSS评分提高率K—LⅡ级患者显著高于Ⅲ级、Ⅳ级（P〈0．05）。【结论】对于HSS评分〉60分或HSS评分〈60分且K—L分级Ⅱ级以上的患者采用关节镜清创及术后康复相结合治疗具有较好的疗效,但是对于HSS评分〈60分且K—L分级为Ⅲ级、Ⅳ级患者的治疗效果并不理想,可以考虑采用其他治疗方式。     

A prognostic approach to defining chronic pain: application to knee pain in older adults

A prognostic approach to defining chronic pain has been proposed as an alternative to traditional definitions based on retrospective duration of pain. While this new approach performs well in low back pain (LBP), headache and orofacial pain, it is not known whether it translates to regional pain syndromes with an underlying pathological component, such as osteoarthritis (OA). We investigated the performance of this approach in a population-based cohort of older adults reporting knee pain, with a spectrum of radiographic knee OA. 676 adults (50 years+) attended a research clinic and were followed up at 18 months and 3 years. Risk scores were calculated using pain intensity, pain duration, pain-related activity, number of pain sites and depressive symptoms, measured at baseline and at 18 months. These scores were used to determine the probability of future clinically significant knee pain, defined as Chronic Pain Grade II-IV, at 18 months and at 3 years using logistic regression. Cut-points on the risk score were applied to determine groups at intermediate (probability >or=0.2), possible (>or=0.5) and probable (>or=0.8) risk of clinically significant knee pain. Discriminative ability of the risk scores, determined by area under the ROC curve, was high (0.78-0.82), varied little by radiographic severity and was superior to pain duration alone. The derived cut-points suggested a lower threshold for each of the risk groups than the previous LBP work. This prognostic approach to defining chronic pain appears to translate well to knee pain. Different cut-points for defining risk groups may be needed for different pain syndromes.     

Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee

Objective: The aim was to assess sensitization using quantitative sensory testing in mechanical and thermal modes in individuals with and without osteoarthritis (OA) of the knee. Pain thresholds were correlated with functionality, symptoms of depression and intensity of pain. Methods: Thirty control volunteers and 30 patients with OA of the knee were assessed. Punctate pain thresholds using Von Frey filaments and thermal pain thresholds using a Thermal Sensory Analyzer were evaluated in the periarticular region of the knee and forearm. Using a digital pressure algometer, pressure pain thresholds were assessed in the periarticular region of the knee and on the root exit zone on the lumbar and sacral spine. Results: Punctate, pressure, and thermal pain thresholds differed significantly between participants with and without OA (p < 0.05). Values in those with OA were consistent with pain sensitization. Pressure pain thresholds also showed moderate and negative correlations with data on functionality, symptoms of depression and intensity of pain (?0.36 < r > ?0.56), contributing up to 30% of their variability. Conclusions: Allodynia and hyperalgesia were demonstrated in the OA group, suggesting central sensitization in patients with mild to moderate severity of joint damage. Correlation between mechanical hypersensitivity and psychosocial factors seems to be small, despite of its significance.     

Efficacy,safety, and tolerability of fulranumab,an anti-nerve growth factor antibody,in the treatment of patients with moderate to severe osteoarthritis pain

Nerve growth factor (NGF) is increased in chronic pain conditions. This study examined analgesic efficacy and safety of fulranumab, a fully human monoclonal anti-NGF antibody, in adults with chronic osteoarthritis pain. Patients (n = 466, intent-to-treat) were randomized to receive, in addition to their current pain therapy, subcutaneous injections in 1 of 6 parallel treatment groups: placebo (n = 78), fulranumab 1 mg (n = 77) or 3 mg (n = 79) every 4 weeks (Q4wk), 3 mg (n = 76), 6 mg (n = 78), or 10 mg (n = 78) every 8 weeks (Q8wk). Primary efficacy results showed that fulranumab significantly reduced the average pain intensity score (P ? 0.030) from baseline to week 12 compared with placebo in the 3mgQ4wk, 6mgQ8wk, and 10mgQ8wk groups. Secondary efficacy outcomes indicated that significant improvement occurred compared with placebo at week 12 on the Western Ontario and McMaster Universities Osteoarthritis Index subscales of pain, stiffness, and physical function (P < 0.040) across all fulranumab groups except 1mgQ4wk, on the Brief Pain Inventory–Short Form subscales of pain intensity (P ? 0.016) and pain interference (P ? 0.030) in the 3mgQ4wk and 10mgQ8wk groups, and on the Patient Global Assessment score (P ? 0.040) in the 3mgQ4wk, 6mgQ8wk, and 10mgQ8wk groups. The most common (?5% of patients) treatment-emergent adverse events in overall fulranumab groups during the first 12 weeks included paresthesia (7%), headache (5%), and nasopharyngitis (5%). Most neurologic-related treatment-emergent adverse events were mild or moderate and resolved at the end of week 12. Serious adverse events occurred in 3 patients, but they were not neurologically related and resolved before study completion. Fulranumab treatment resulted in statistically significant efficacy in pain measures and physical function versus placebo and was generally well tolerated.     

半月板损伤的磁共振诊断与关节镜检查对照分析

目的探讨MRI和关节镜在半月板损伤中的诊断价值。方法对60（膝）例临床拟诊半月板损伤的MRI和关节镜检查结果作对照分析。结果60膝MRI确诊半月板损伤,关节镜发现半月板撕裂51个膝关节,与MRI诊断半月板Ⅲ级信号49个膝关节的结果相近。结论MRI是诊断半月板破裂极有价值的无创方法,是膝关节镜术前的重要检查。MRI与临床诊断相结合可提高半月板撕裂伤的诊断率,避免不必要的关节镜手术。