关节镜下清理结合黏弹性补充治疗踝退行性骨关节病的临床疗效分析

目的:探讨关节镜下清理结合黏弹性补充对踝退行性骨关节病的治疗作用。方法:回顾性分析2008年10月至2012年5月保守治疗无效,踝退行性骨关节病患者30例,行踝关节镜治疗,术后按计划行踝关节玻璃酸钠关节腔注射,平均随访(2.5±0.6)年,2例失访。男19例,女9例;年龄28～56岁,平均(40.0±5.9)岁。排除先天发育异常;创伤引起的骨折畸形愈合;曾经发生过感染;以往有关节镜手术史;半年内行关节内皮质激素注射史;神经肌肉系统疾病及严重内科病;妊娠;除外类风湿、痛风、结核等疾病所致关节炎。由同一术者对关节软骨损伤用Outerbridge分级,对患者在局麻下行关节镜下滑膜清除,软骨修整,骨赘磨削。所有病例未实施微骨折术,术后按治疗计划行踝关节腔透明质酸钠注射。术后采用Ogilvie-Harris标准对结果进行评价。结果:根据Ogilvie-Harris标准,本组优10例,良14例,一般3例,差1例。主观疼痛评分(VAS)由术前7.5±1.3改善至术后2.4±2.3(P=0.00);踝背伸活动度(ROM-D)术前(27.0±7.3)°,术后(29.0±5.6)°,无显著改善(P=0.26);Tegner运动水平评分术前2.7±1.3,术后5.6±2.2,评分提高(P=0.00)。结论:推荐在治疗踝退行性骨关节病时应用关节镜下滑膜清除,骨赘磨削,软骨修整术和术后按计划行关节内透明质酸钠注射。

Analysis on arthroscopic debridement and visco supplement for the treatment of degenerative osteoarthropathy of ankle

Objective:To evaluate effects of arthroscopic debridement and visco supplement for the treatment of degenerative osteoarthropathy of ankle. Methods:From October 2008 to May 2012,30 patients with degenerative osteoarthropathy of ankle were treated with arthroscopy after ineffective treatment with conservative methods. Two patients lost follow-up. Among the patients,19 patients were male and 9 patients were female,ranging in age from 28 to 56 years old,with a mean of(40.0±5.9)years old. Patients who had inflammatory or postinfectious arthritis,rheumatoid,gout,tuberculosis were excluded. Other exclusion criteria included previous arthroscopic treatment for ankle osteoarthropathy,intraarticular corticosteroid injection within the previous 6 months,a major neurologic deficit,serious medical illness and pregnancy. Articular cartilage injuries were classified according to Outerbridge by the same doctor. Follow procedures were involved in the surgery:synovectomy,debridement or excision of fragments of articular cartilage or chondral flaps and osteophytes that prevented full extension. Microfracture of chondral defects was not performed. Ogilvie-Harris criteria was used to evaluate therapeutic effects. Results:According to Ogilvie-Harris criteria,10 patients got an excellent results,14 good,3 poor and 1 bad. The mean VAS score of pain decreased from preoperative 7.5±1.3 to postoperative 2.4±2.3. The score of dorsiflexion range(ROM-D) had no obvious change after operationpreoperative(27.0±7.3)degree and postoperative(29.0±5.6)degree]. The mean Tegner score increased from preoperative 2.7±1.3 to postoperative 5.6±2.2. Conclusion:Synovectomy,debridement or excision of chondral flaps and osteophytes under arthroscopy,as well as scheduled intraarticular sodium hyaluronate injection should be recommened to treat ankle degenerative osteoarthropathy.