关节镜下微骨折术联合玻璃酸钠注射治疗膝关节软骨损伤
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摘要
目的探讨关节镜下微骨折术联合关节腔内注射玻璃酸钠对膝关节软骨损伤的治疗效果。方法将2015年1月至2016年12月收治的64例膝关节软骨损伤患者分为两组,对照组32例单纯采取关节镜下微骨折术治疗,观察组32例采用关节镜下微骨折术联合玻璃酸钠关节腔注射治疗;根据Outerbridge分级(Ⅱ~Ⅳ度)将两组患者各分为3组,比较不同损伤程度患者治疗效果;术后随访8~23个月,采用美国纽约特种外科医院(HSS)评分对手术前后膝关节功能进行评分,评估疗效。结果末次随访时观察组HSS评分明显提升,与对照组比较差异有统计学意义(P<0.05);观察组膝关节功能恢复优良率为93.75%(30/32),明显高于对照组81.25%(26/32);对照组与观察组各组间HSS评分差异有统计学意义(P<0.05),修复情况与损伤程度呈正相关。结论关节镜下微骨折术联合关节腔内注射玻璃酸钠治疗膝关节软骨损伤具有良好的近期疗效,优于单用关节镜下微骨折术治疗,并且修复效果因损伤程度不同而存在差异。
Objective To investigate the therapeutic effect of arthroscopic micro fracture combined with intraarticular injection of sodium hyaluronate on the injury of knee cartilage. Methods From January 2015 to December 2016, 64 cases of knee joint cartilage injury patients were divided into two groups, 32 cases in control group were treated by arthroscopic microfracture, 32 cases in observation group were treated with arthroscopic microfracture combined with sodium hyaluronate treatment; the two groups were divided into 3 groups according to the Outerbridge classification(II ~ IV), comparing the therapeutic effect of different degree of injury therapy; patients were followed up for 8 ~ 23 months, the New York hospital for special surgery(HSS) score were evaluated before operation and last follow-up to evaluate the efficacy of knee joint function. Results At the last follow-up, the HSS score of the observation group improved significantly, there was statistically significant difference compared with control group(P<0.05); observation group of knee joint function recovery rate was 93.75%(30/32), higher than the control group 81.25%(26/32); the control group and the observation group HSS score differences between groups was statistically significant(P<0.05), there is a positive correlation between the condition of repair and the degree of injury.Conclusion Arthroscopic microfracture combined with intra-articular injection of sodium hyaluronate has a good short-term effect in the treatment of knee cartilage injury,it is superior to arthroscopic micro fracture surgery, and the repair effect is different due to different degree of injury.
Objective To investigate the therapeutic effect of arthroscopic micro fracture combined with intraarticular injection of sodium hyaluronate on the injury of knee cartilage. Methods From January 2015 to December 2016, 64 cases of knee joint cartilage injury patients were divided into two groups, 32 cases in control group were treated by arthroscopic microfracture, 32 cases in observation group were treated with arthroscopic microfracture combined with sodium hyaluronate treatment; the two groups were divided into 3 groups according to the Outerbridge classification(II ~ IV), comparing the therapeutic effect of different degree of injury therapy; patients were followed up for 8 ~ 23 months, the New York hospital for special surgery(HSS) score were evaluated before operation and last follow-up to evaluate the efficacy of knee joint function. Results At the last follow-up, the HSS score of the observation group improved significantly, there was statistically significant difference compared with control group(P<0.05); observation group of knee joint function recovery rate was 93.75%(30/32), higher than the control group 81.25%(26/32); the control group and the observation group HSS score differences between groups was statistically significant(P<0.05), there is a positive correlation between the condition of repair and the degree of injury.Conclusion Arthroscopic microfracture combined with intra-articular injection of sodium hyaluronate has a good short-term effect in the treatment of knee cartilage injury,it is superior to arthroscopic micro fracture surgery, and the repair effect is different due to different degree of injury.
引文
[1]张建伟.微骨折术联合玻璃酸钠注射修复膝关节软骨损伤[J].河南医学研究,2016(10):1842.
[2]刘建,徐萍,李红,等.关节镜下关节清理联合缺损区微骨折术治疗膝关节软骨缺损临床观察[J].山东医药,2009(42):83-84.
[3]Marshall J L,Fetto J F,Botero P M.Knee ligament injuries:a standardized evaluation method[J].Clin Orthop Relat Res,1977(123):115-129.
[4]蒋协远,王大伟.骨科临床疗效评价标准[M].第一版.北京:人民卫生出版社,2005.369.
[5]孙开军,李宽新,郭二鹏,等.关节镜下清理术改善膝关节骨关节炎患者临床症状有效性的Meta分析[J].海南医学,2015(05):747-752.
[6]韩成龙,温洪鹏,陈潮宇,等.关节镜下微骨折术与Pridie钻孔术修复膝关节软骨全层损伤疗效对比研究[J].海南医学,2016(12):1953-1955.
[7]王泽民,黄江鸿,段莉,等.自体软骨细胞移植术治疗关节软骨损伤的研究进展[J].中国矫形外科杂志,2015(04):328-331.
[8]张卫东,杨柳,唐康来,等.关节镜下微骨折术治疗膝关节软骨缺损临床疗效观察[J].重庆医学,2005(07):980-981.
[9]左镇华,杨柳,段小军,等.关节镜下微骨折技术治疗膝关节软骨缺损的近期临床疗效评价[J].重庆医学,2006(20):1834-1836.
[10]林松,吴昌新,何和与.微骨折术修复关节软骨缺损[J].中国矫形外科杂志,2010(02):168-169.
[11]张松涛,郭耀松,张冠军.玻璃酸钠联合止痛消炎软膏或醋酸曲安奈德注射治疗膝骨关节炎120例临床观察[J].中医临床研究,2015(21):64-65.
[12]郑海龙,魏立,唐强.微骨折术与自体骨软骨移植治疗距骨骨软骨损伤的早期临床结果[J].创伤外科杂志,2017(08):595-597.
[13]滕磊.关节镜微骨折术治疗膝关节软骨损伤的效果分析[J].临床医药文献电子杂志,2017,4(34):6547-6548.
[14]付昌马,钱春生,章有才.微骨折术联合玻璃酸钠注射修复膝关节软骨损伤[J].实用骨科杂志,2013(02):109-111.
[15]伏治国,瞿玉兴.关节镜下微骨折技术联合关节内注射玻璃酸钠修复膝关节软骨缺损[J].东南大学学报(医学版),2012(02):196-198.
[16]胡志喜,贺用礼,毛炳炎,等.关节镜下微骨折术治疗膝关节软骨缺损临床疗效观察[J].中国现代医生,2012(35):36-37.
[2]刘建,徐萍,李红,等.关节镜下关节清理联合缺损区微骨折术治疗膝关节软骨缺损临床观察[J].山东医药,2009(42):83-84.
[3]Marshall J L,Fetto J F,Botero P M.Knee ligament injuries:a standardized evaluation method[J].Clin Orthop Relat Res,1977(123):115-129.
[4]蒋协远,王大伟.骨科临床疗效评价标准[M].第一版.北京:人民卫生出版社,2005.369.
[5]孙开军,李宽新,郭二鹏,等.关节镜下清理术改善膝关节骨关节炎患者临床症状有效性的Meta分析[J].海南医学,2015(05):747-752.
[6]韩成龙,温洪鹏,陈潮宇,等.关节镜下微骨折术与Pridie钻孔术修复膝关节软骨全层损伤疗效对比研究[J].海南医学,2016(12):1953-1955.
[7]王泽民,黄江鸿,段莉,等.自体软骨细胞移植术治疗关节软骨损伤的研究进展[J].中国矫形外科杂志,2015(04):328-331.
[8]张卫东,杨柳,唐康来,等.关节镜下微骨折术治疗膝关节软骨缺损临床疗效观察[J].重庆医学,2005(07):980-981.
[9]左镇华,杨柳,段小军,等.关节镜下微骨折技术治疗膝关节软骨缺损的近期临床疗效评价[J].重庆医学,2006(20):1834-1836.
[10]林松,吴昌新,何和与.微骨折术修复关节软骨缺损[J].中国矫形外科杂志,2010(02):168-169.
[11]张松涛,郭耀松,张冠军.玻璃酸钠联合止痛消炎软膏或醋酸曲安奈德注射治疗膝骨关节炎120例临床观察[J].中医临床研究,2015(21):64-65.
[12]郑海龙,魏立,唐强.微骨折术与自体骨软骨移植治疗距骨骨软骨损伤的早期临床结果[J].创伤外科杂志,2017(08):595-597.
[13]滕磊.关节镜微骨折术治疗膝关节软骨损伤的效果分析[J].临床医药文献电子杂志,2017,4(34):6547-6548.
[14]付昌马,钱春生,章有才.微骨折术联合玻璃酸钠注射修复膝关节软骨损伤[J].实用骨科杂志,2013(02):109-111.
[15]伏治国,瞿玉兴.关节镜下微骨折技术联合关节内注射玻璃酸钠修复膝关节软骨缺损[J].东南大学学报(医学版),2012(02):196-198.
[16]胡志喜,贺用礼,毛炳炎,等.关节镜下微骨折术治疗膝关节软骨缺损临床疗效观察[J].中国现代医生,2012(35):36-37.