关节镜手术治疗对早期膝骨关节炎的中期临床疗效

目的：比较关节镜手术治疗与保守治疗对中老年人早期膝关节骨关节炎（early knee osteoarthritis，EKOA）的中期临床疗效，为中老年EKOA的个体化治疗提供临床依据。方法：回顾性纳入2015年1月至2016年12月行关节镜手术治疗或保守治疗的145例（182膝）中老年EKOA患者，其中男35例、女110例，年龄47~79（57.6±6.9）岁，病程6~48（14.6±8.9）个月。根据治疗方式分为关节镜治疗组（47例，58膝）和保守治疗组（98例，124膝）。治疗前患者主要临床症状包括膝关节疼痛、肿胀、交锁、屈伸受限及膝关节无力等，膝关节X线主要表现为关节间隙无狭窄或可疑狭窄、少量骨赘形成，膝关节MRI主要表现为关节软骨和半月板退变或损伤、关节内游离体及滑膜充血水肿等。收集两组患者治疗前的膝关节症状持续时间、半月板是否合并损伤、是否合并关节内游离体、是否存在膝关节交锁等机械性症状，以及治疗前和治疗后的疼痛视觉模拟评分（visual analogue scale，VAS）和Lysholm膝关节功能评分。统计分析组内和组间治疗前后VAS和Lysholm评分差异。结果：两组患者均获随访，时间60~76个月；关节镜手术组患者切口愈合良好，未发生手术并发症。两组间的年龄、性别、身体质量指数（body mass index，BMI）及随访时间差异无统计学意义（P>0.05）。治疗前，关节镜治疗组与保守治疗组相比，关节镜治疗组的症状持续时间更长（P<0.001），合并半月板损伤（P<0.001）、游离体（P=0.001）及机械性症状（P<0.001）的比例更高，VAS评分（P<0.001）及Lysholm评分（P<0.001）更差。治疗后末次随访时，各组VAS评分、Lysholm评分均较治疗前明显改善（P<0.05）。末次随访时，VAS评分，关节镜治疗组（1.5±1.2）分，保守治疗组（1.6±1.0）分（P=0.549）；Lysholm评分，关节镜治疗组（84.9±12.5）分，保守治疗组（84.2±9.9）分（P=0.676）。结论：对中老年EKOA患者，关节镜手术治疗与保守治疗均具有较满意的中期临床疗效。尽管两组末次随访时疗效差异无统计学意义，但关节镜手术治疗组术前症状较重，多合并半月板损伤或游离体所导致的机械性交锁症状，故对于合并机械性交锁症状或保守治疗效果较差的中老年EKOA患者可考虑关节镜手术治疗。

Mid-term clinical outcome of arthroscopic surgery on early knee osteoarthritis in middle-old aged patients

Objective To compare the mid-term clinical effect of arthroscopic surgery versus conservative treatment on the middle aged early knee osteoarthritis (EKOA) patients, with the hope to provide clinical evidence for their individual therapy.Methods A total of 145 middle aged EKOA patients(182 knees) who received arthroscopic surgery or conservative treatment from January 2015 to December 2016 were retrospectively enrolled, including 35 males and 110 females, aged from 47 to 79 years old with an average of (57.6±6.9) years old, and the duration of disease ranged from 6 to 48 months with an average of(14.6±8.9) months. According to treatment method, patients were divided into arthroscopic surgery group (47 patients, 58 knees) and conservative treatment group(98 patients, 124 knees). Before treatment, patients presented with symptoms of knee joint, such as pain, swelling, locking, limited flexion and extension, and weakness, as well as abnormal findings in knee X-ray (without or suspicious joint space narrow, and a few of osteophyte formation) or in knee MRI (injury or degeneration of articular cartilage or meniscus, loose body in the joint cavity and synovial hyperemia edema, etc). Related data were collected, including duration of knee symptoms, presence of meniscus injury, loose body in the joint cavity or mechanical symptoms such as locking, and visual analogue scale (VAS) and Lysholm knee function score before treatment and at the latest follow-up. Statistical analysis was performed to compare the differences in VAS or Lyshilm score before or after treatment between the low groups and within each group.Results Patients in the two groups were followed up from 60 to 76 months. In the arthroscopic surgery group, the incision healing was good and no surgical complications occurred. There were no significant differences in age, gender, BMI and follow-up time between the two groups(P>0.05). Before treatment, compared with conservative group, duration of symptoms in the arthroscopic group was longer (P<0.001), comorbidity rates of meniscus injury (P<0.001), free body (P=0.001) and mechanical symptoms (P<0.001) were higher, VAS (P<0.001) and Lysholm score (P<0.001) were worse. At the final follow-up, VAS and Lysholm score in either the conservative group or the arthroscopic group were significantly better than before treatment (P<0.05), while no significant differences between the two groups were found. The VAS was (1.5±1.2) scores in the arthroscopic group and (1.6±1.0)scores in the conservative group(P=0.549), and the Lysholm score was (84.9±12.5) scores in the arthroscopic group and (84.2±9.9) scores in the conservative group (P=0.676).Conclusion Both arthroscopic surgery and conservative treatment have satisfactory intermediate clinical effect middle- aged patients with EKOA, without statistically differences. However, most of the patients before surgery in the arthroscopic treatment group had mechanical locking symptoms caused by meniscus injury or loose body. Therefore, for the middle-aged EKOA patients with mechanical locking symptoms or without obtaining satisfactory outcome after conservative treatment, arthroscopic surgery may be considered.