膝关节滑膜病行关节镜清理术的疗效及其预后因素的分析

目的观察关节镜清理术在膝关节滑膜病变中的诊疗价值并探讨影响其疗效的可能因素。方法对55例(55膝)术后诊断为滑膜病变的膝关节疾病患者,运用2000IKDC评价其患膝术前、术后的功能状况,对其中的创伤性滑膜炎患者同时采用2000IKDC评分、Lysholm评分和改良Cincinnati评分、Tegner和Lysholm运动水平评级标准及SF-36进行综合评价,并以性别、年龄、BMI为分组条件进行分组并分析其结果的差异性;采用2000IKDC评分中的疼痛指标探究关节镜手术对创伤性滑膜炎关节疼痛的改善情况。结果完整随访到45例患者(45膝),平均随访时间为41.29(12～81)个月,随访率为81.8%。慢性滑膜炎组IKDC评分由术前平均48.66分上升到术后79.23分,改善率为54.08%(P0.05);PVNS组2000IKDC评分由术前平均45.31分上升到术后72.23分,改善率为45.10%(P0.05)。对于创伤性滑膜炎,2000IKDC评分平均由术前51.61分上升到术后73.98分,Lysholm评分平均由术前68.45分上升到术后86.36分,改良Cincinnati评分平均由术前64.81分上升到术后80.82分;SF-36评分中,生理职能得分平均由术前60.11分上升为术后80.04分,心理职能评分平均从术前34.75分上升至术后68.47分。Tegner和Lysholm运动水平评级从术前的3级上升为术后的6级。以性别、年龄、BMI作为分组条件,各组间比较均无统计学意义(P0.05)。手术过后患者的疼痛次数明显减少(4～8),疼痛程度也有所改善(7～9)。结论关节镜下清理术对于膝关节滑膜慢性病变具有较为显著的疗效,但是对于PVNS行关节镜下关节清理术时应慎重。关节镜下清理术对于创伤性滑膜炎疗效满意,在缓解疼痛肿胀方面效果佳,性别、年龄、BMI对于患者疗效的影响不大。

Study on the outcomes of the arthroscopic debridement for the knee arthrosynovitis and its significant factors

Objective To investigate the therapeutic value of arthroscopic debridement in the patients with knee arthrosynovitis and study the potential factors which might influence the outcome.Methods 55 cases （55 knees） of arthrosynovitis were evaluated by 2000 IKDC.The group of traumatic synovitis was separately evaluated by 2000 IKDC,Lysholm score,Modified Cincinnati score,Lysholm and Tegner activity rating scale and SF-36.Then they were grouped by gender,age,or BMI and analyzed.The amelioration of pain in these patients was studied by the pain index of the 2000 IKDC.Results 45 cases （45 knees） were completely followed up with an average of 41.29 （12-81） months and a rate of 81.8%.In the group of chronic arthrosynovitis,the mean 2000 IKDC score improved from 48.66 to 79.23,with an improvement rate of 54.08% （P〈0.05）.And it also improved from 45.31 to 72.23 in the PVNS group,with an improvement rate of 45.10% （P〈0.05）.In the group of traumatic synovitis,2000 IKDC mean score improved from 51.61 to 73.98 （P〈0.05）,Lysholm mean score improved from 68.45 to 80.82 （P〈0.05）,and Modified Cincinnati mean score improved from 64.81 to 80.82 （P〈0.05）.In SF-36,the mean physical health score improved from 68.45 to 80.04,while the general psychological mean score improved from 34.75 to 68.47.In Lysholm and Tegner activity rating scale,the rank improved from 3 to 6.The results of the variability analysis in different groups of gender,age,and BMI suggested no statistical significance （P〉0.05）.The times of pain decreased obviously after surgery （4-8）,and also the relief of pain improved （7-9）.Conclusions Arthroscopic debridement has good curative effects for chronic arthrosynovitis,but it should be carefully considered in the patient of PVNS.Arthroscopic debridement has satisfactory effects on the traumatic synovitis,and the improvement of pain and swelling is obvious too.But Gender,age,or BMI has no influence on the therapeutic effect in these patients.