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。

Efficacy of Debridement Under Arthroscopy and Rehabilitation Treatment on HSS Scores of Dif-ferent-Stage KL Patients with Osteoarthritis

Obj ective]To investigate the efficacy of arthroscopic treatment and postoperative rehabilitation therapy on osteoarthritis patients with New York Hospital for Special Surgery Knee scores (HSS)and the Kellgren-Lawrance (KL)grades.[Methods]A retrospective analysis of 120 cases of arthroscopic debridement and postoperative rehabilitation (126 knees)collected from 2010 to 2013 in the Orthopedics department of the Liuzhou Chinese Traditional Medical Hospital was conducted.Patients were grouped according to HSS scores and KL grading criteria.Comparative analysis of knee function score in patients under the circumstance change was implemented.[Results]HSS scores in patients with preoperative HSS> 70 and KL grade Ⅰ,grade Ⅱ, or grade Ⅲ significantly increased postoperatively(P <0.05).The rates of improvement in HSS among the three KL grade groups were not significantly different (P >0.05).This pattern was also present in patients with preoperative HHS scores of 60 to 69:HHS scores of patients in KL grade Ⅰ,grade Ⅱ,and grade Ⅲsignificantly increased (P <0.05)postoperatively,and the improvement rates of the three groups were not significant different(P >0.05).HSS scores in patients with preoperative HHS scores <60 in the KL gradeⅡgroup increased significantly postoperatively(P <0.05).However,HSS scores in patients in the KL grade Ⅲand grade Ⅳgroups were not significantly (P >0.05).After treatment,HSS score increase in the K-L gradeⅡ group was significantly higher than in patients in the K-L grade Ⅲ and Ⅳ groups (P <0.05).[Conclu-sion]For patients with preoperative HSS scores >60 or <60 and KL grade Ⅱ or above,arthroscopic debride-ment and postoperative rehabilitation therapy have a positive effect.However,for patients with preoperative HSS scores <60 and KL grade level Ⅲ or IV,other treatment modalities should be considered.