关节镜治疗更年期女性膝关节退变
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摘要
目的探讨关节镜下清理术治疗更年期女性膝关节退变的临床疗效。
方法对我院骨关节科2007年11月一2009年10月经口服非甾体类抗炎药、物理治疗及关节腔内注射透明质酸钠等严格保守治疗无效的97例(116膝)更年期女性膝关节退变患者行膝关节镜下清理术,术后随访一个月待膝关节腔内无积液存在且肿胀消退后进行Lysholm评分并计算优良率以观察临床疗效；之后在对术后患者随访观察过程中随机抽样每周一次膝关节腔内注射透明质酸钠2mL,连续共5次为1个疗程,疗程结束后按Lysholm膝关节评分系统评分并计算优率以进行临床疗效对比,之后继续进行随访观察6-12个月。
结果97例(116膝)患者关节镜下清理术后1个月Lysholm评分(83.7+5.5)分及优良率84.48%和术后一年Lysholm评分(91.3±4.9)及优良率92.24%均明显高于术前Lysholm评分(53.4±4.3)分及优良率4.31%(p<0.01)(见附表1、2及图1、2)；术后一个月起随机抽样随访患者52例作为注射组每周一次膝关节腔内注射透明质酸钠注射后的Lysholm评分(94.5±4.1)分及优率57.69%明显高于未注射组54例的Lysholm评分(82.1±3.7)分及优率34.62%(p<0.05)(见附表3、4及图1、2)。
结论关节镜下清理术治疗更年期女性膝关节退变损伤小、并发症少、术后恢复快,可明显缓解疼痛和改善关节功能,是目前治疗更年期女性膝关节退变理想的方法。而关节镜下清理术后关节腔内注射透明质酸钠可以有效地改善患者症状,是目前辅助治疗更年期女性膝关节退变的一种较好的方法。
Objective:Clinical observation of arthroscopic debridement in treating degenerative knee of menopausal women.
Methods:Ninety-seven cases(116knees) of degenerative knee of menopausal women which had no reaction with strict conservative treatment just like oral nonsteroidal anti-inflammatory drugs, physiotherapy and articular injection of sodium were treated with arthroscopic debfidements,all the patients were followed up for one month to confirm the knee joint cavity swelling disappeared without effusion then to Lysholm score and the excellent and good rate of clinical effects;Patients were random sampling among the followed up after the postoperative course of knee joint cavity weekly sodium hyaluronate injection 2mL,5 consecutive times as a course of treatment, after the treatment, according to Lysholm knee scoring system and calculate the rates of clinical efficacy, then continue observe for 6-12 months.
Result:97 patients (116 knees) patients Arthroscopic surgery 1 month Lysholm score (83.7±5.5) and good rate of 84.48%, and after a year Lysholm score (91.3±4.9) and good rate of 92.24% was higher than preoperative Lysholm score (53.4±4.3) and good rate of 4.31%(p <0.01) (Table 1,2 and chart 1,2); Random sample from the knee joint cavity of patients weekly injections of sodium hyaluronate injection after one month, Injection group's Lysholm score (94.5±4.1) and had a good rate of 57.69% was significantly higher than not injection's Lysholm score (82.1±3.7) and excellent rate of 34.62%(p<0.05) (Table 3,4 and chart 3,4).
Conclusion:The arthmscopic treatment of degenerative knee injury in menopausal women, fewer complications, faster recovery after surgery can significantly relieve pain and improve joint function, is an ideal method for degenerative knee joint in menopausal women; Intra-articular injection of sodium hyaluronate after arthroscopy debridement can be effective in improving symptoms, is a better way in the adjuvant treatment of degenerative knee menopausal women.
方法对我院骨关节科2007年11月一2009年10月经口服非甾体类抗炎药、物理治疗及关节腔内注射透明质酸钠等严格保守治疗无效的97例(116膝)更年期女性膝关节退变患者行膝关节镜下清理术,术后随访一个月待膝关节腔内无积液存在且肿胀消退后进行Lysholm评分并计算优良率以观察临床疗效；之后在对术后患者随访观察过程中随机抽样每周一次膝关节腔内注射透明质酸钠2mL,连续共5次为1个疗程,疗程结束后按Lysholm膝关节评分系统评分并计算优率以进行临床疗效对比,之后继续进行随访观察6-12个月。
结果97例(116膝)患者关节镜下清理术后1个月Lysholm评分(83.7+5.5)分及优良率84.48%和术后一年Lysholm评分(91.3±4.9)及优良率92.24%均明显高于术前Lysholm评分(53.4±4.3)分及优良率4.31%(p<0.01)(见附表1、2及图1、2)；术后一个月起随机抽样随访患者52例作为注射组每周一次膝关节腔内注射透明质酸钠注射后的Lysholm评分(94.5±4.1)分及优率57.69%明显高于未注射组54例的Lysholm评分(82.1±3.7)分及优率34.62%(p<0.05)(见附表3、4及图1、2)。
结论关节镜下清理术治疗更年期女性膝关节退变损伤小、并发症少、术后恢复快,可明显缓解疼痛和改善关节功能,是目前治疗更年期女性膝关节退变理想的方法。而关节镜下清理术后关节腔内注射透明质酸钠可以有效地改善患者症状,是目前辅助治疗更年期女性膝关节退变的一种较好的方法。
Objective:Clinical observation of arthroscopic debridement in treating degenerative knee of menopausal women.
Methods:Ninety-seven cases(116knees) of degenerative knee of menopausal women which had no reaction with strict conservative treatment just like oral nonsteroidal anti-inflammatory drugs, physiotherapy and articular injection of sodium were treated with arthroscopic debfidements,all the patients were followed up for one month to confirm the knee joint cavity swelling disappeared without effusion then to Lysholm score and the excellent and good rate of clinical effects;Patients were random sampling among the followed up after the postoperative course of knee joint cavity weekly sodium hyaluronate injection 2mL,5 consecutive times as a course of treatment, after the treatment, according to Lysholm knee scoring system and calculate the rates of clinical efficacy, then continue observe for 6-12 months.
Result:97 patients (116 knees) patients Arthroscopic surgery 1 month Lysholm score (83.7±5.5) and good rate of 84.48%, and after a year Lysholm score (91.3±4.9) and good rate of 92.24% was higher than preoperative Lysholm score (53.4±4.3) and good rate of 4.31%(p <0.01) (Table 1,2 and chart 1,2); Random sample from the knee joint cavity of patients weekly injections of sodium hyaluronate injection after one month, Injection group's Lysholm score (94.5±4.1) and had a good rate of 57.69% was significantly higher than not injection's Lysholm score (82.1±3.7) and excellent rate of 34.62%(p<0.05) (Table 3,4 and chart 3,4).
Conclusion:The arthmscopic treatment of degenerative knee injury in menopausal women, fewer complications, faster recovery after surgery can significantly relieve pain and improve joint function, is an ideal method for degenerative knee joint in menopausal women; Intra-articular injection of sodium hyaluronate after arthroscopy debridement can be effective in improving symptoms, is a better way in the adjuvant treatment of degenerative knee menopausal women.
引文
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[2]NEVITT M C, FELSON D T. Sex hormones and the risk of osteoarthritis in women:epidemiologieal evidence [J]. Ann R heum Dis,1996,55(9):673-676.
[3]周立平,徐中和.膝骨关节炎的关节镜治疗[J].中国内镜杂志,2000,6(2)：71-72.
[3]ZHOU L P,XU Z H. Arthroscopic treatment for osteoart-hritis of the knee[J].China Journal of Endoscopy,2000,6(2):71-72.Chinese
[4]刘勇章,晨,张德常,等.膝关节骨关节炎关节镜术及透明质酸关节内注射的疗效观察[J].中国内镜杂志,2003,9(2)：46.
[4]LIU YZ, IN C, ZHANG DC, et al. Evaluation of oarthr-eseopy and intra-articular injection of hyaluronic acid on osteoarthritis of the knee[J].China Journal of Endosco-py,2003,9(2):46.Chinese
[5]LYSHOLM J, GILLQUI S T J. Evaluation of knee ligamerit surge ry results with special emphasis on use of ascoring scale[J].Am J Sp-orts Med,1982, 100(3):150-154.
[6]刘剜榕,雌激素治疗更年期综合征[J].临床和实验医学杂志,2006,4(5)：415.
[7]DIEPPE P. Subchondral bone should be the main target for the treatment of pain and disease progression in osteoarthritis [J]. Osteoarthritis Cartilage,1999,7(3): 325-326.
[8]BEHETS C, WILLIAMS J M, CHAPPARD D, et al. Effects of calcitonin on subchondral trabecular bone changes and on osteoarthritic cartilage lesions after acute anter ior cruciate ligament deft-ciency[J]. J Bone Miner Res,2004, 19(11):1821-1826
[9]HAMK D, CARLSON C S. Effects of estrogen replacement therapy on bone turnover in subchondral bone and epiphyseal metaphyseal cancellous bone of ovariectomized cynomolgus monKeys[J]. J Bone Miner Res,2004,19(5): 823-829.
[10]梁祖建,李钊,张还添,等.绝经后骨关节炎内源性雌激素水平对软骨下骨影响的实验研究.广东医学,2009,30(4)：510-512
[11]KIMBLE R B, MATAYOSHI A B, VANNICE J L, et al. Simu laneous block of interleukin-1 and turner necrosisfactor is required to completely prevent bone loss in the early postovarieetomy period [J]. Endocrinology,1995,136 (7): 3054-3061.
[12]樊孝俊,陈道振,眭承志.雌激素和细胞因子与骨性关节炎的关系,中国医药导报,2007,4(45)
[13]Wluka A E, Cicuttini F M, Spector TM. Menopause, oestrogens and arthritis. Maturitas,2000,35:183-199.
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