張澤

[摘要]目的 探討膝關(guān)節(jié)鏡治療癥狀性膝關(guān)節(jié)骨關(guān)節(jié)炎的臨床效果。方法 選取2016年1月～2017年7月我院收治的80例癥狀性膝骨性骨性關(guān)節(jié)炎患者作為研究對(duì)象，按照隨機(jī)數(shù)字法分為兩組（對(duì)照組與觀察組），每組各40例。對(duì)照組患者實(shí)施玻璃酸鈉注射液膝關(guān)節(jié)腔內(nèi)注射，觀察組患者在對(duì)照組基礎(chǔ)上，實(shí)施膝關(guān)節(jié)鏡下關(guān)節(jié)清理術(shù)，比較治療過(guò)程中患者的膝關(guān)節(jié)疼痛VAS評(píng)分，治療后患者膝關(guān)節(jié)ROM角度變化和膝關(guān)節(jié)Lysholm功能評(píng)分，統(tǒng)計(jì)兩組患者的臨床效果。結(jié)果 治療后1周和治療后4周，觀察組患者的膝關(guān)節(jié)疼痛VAS評(píng)分低于對(duì)照組（P<0.05）；治療后觀察組患者的膝關(guān)節(jié)ROM角度大于對(duì)照組（P<0.05），膝關(guān)節(jié)Lysholm功能得分高于對(duì)照組（P<0.05）；觀察組患者的治療優(yōu)良率為95.0%，顯著高于對(duì)照組的75.0%，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 針對(duì)存在明顯臨床癥狀的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者，以膝關(guān)節(jié)鏡聯(lián)合玻璃酸鈉治療，可有效緩解患者疼痛，改善膝關(guān)節(jié)功能，提高臨床治療效果。

[關(guān)鍵詞]膝關(guān)節(jié)鏡；膝關(guān)節(jié)骨關(guān)節(jié)炎；疼痛；膝關(guān)節(jié)功能

[中圖分類號(hào)] R394.2 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2018）2（c）-0050-03

[Abstract]Objective To investigate the clinical efficacy of knee arthroscopy in the treatment of symptomatic knee osteoarthritis.Methods 80 cases with symptomatic knee osteoarthritis treated in our hospital from January 2016 to July 2017 were selected as the subjects，and divided into the two groups （control group and observation group） by random table method，40 cases in each group.The control group were treated with intraperitoneal injection of sodium hyaluronate injection in the knee joint.The observation group was treated with knee arthroplasty under the control group.The VAS score of the knee joint pain during the treatment were compared，the joint ROM angle changes，knee Lysholm functional score and the overall clinical treatment between the two groups were compared.Results The VAS score of knee joint pain in the observation group was lower than the control group at 1 week and 4 weeks after treatment（P<0.05）.The ROM angle in the observation group was higher than that in the control group （P<0.05）.The Lysholm function score in the observation group was higher than that in the control group （P<0.05）.The excellent rate of overall treatment in the observation group was 95.0%，which was significantly higher than 75.0% of the control group，the difference was statistically significant （P<0.05）.Conclusion Knee arthritis combined with sodium hyaluronate can effectively relieve pain in patients with knee joint，improve knee function，and improve the clinical effect in the treatment of osteoarthritis of knee joint with obvious clinical symptoms.

[Key words]Knee arthroscopy；Knee osteoarthritis；Pain；Knee joint function

膝骨性關(guān)節(jié)炎是臨床最為常見的膝退行性關(guān)節(jié)疾病，好發(fā)于中老年人群，尤以絕經(jīng)后女性患者居多[1]，病理生理改變以關(guān)節(jié)軟骨退行性變化為主要病因[2]。研究顯示，年齡為60歲以上的老年女性，本病發(fā)生率在50%左右[3]，主要以存在早期的關(guān)節(jié)影像學(xué)改變?yōu)橹?，但多?shù)患者無(wú)明顯臨床癥狀，改變以分子階段為主，針對(duì)此類患者多未能引起足夠的臨床重視。目前對(duì)于本病的治療，建議膝關(guān)節(jié)腔內(nèi)注射玻璃酸鈉，補(bǔ)充外源性的關(guān)節(jié)液進(jìn)而延緩關(guān)節(jié)軟骨的退行性變化，稀釋關(guān)節(jié)腔內(nèi)炎癥介質(zhì)的水平，改善關(guān)節(jié)軟骨的潤(rùn)滑情況，達(dá)到改善關(guān)節(jié)腔內(nèi)滑液的性質(zhì)[4]，提高臨床治療效果的目的。但單純應(yīng)用玻璃酸鈉注射液關(guān)節(jié)腔內(nèi)給藥，雖可于短期內(nèi)針對(duì)患者關(guān)節(jié)癥狀起到一定的改善作用，但治療時(shí)間長(zhǎng)、費(fèi)用高，同時(shí)反復(fù)膝關(guān)節(jié)腔有創(chuàng)穿刺[5]，還有可能導(dǎo)致膝關(guān)節(jié)腔感染，存在一定的醫(yī)療風(fēng)險(xiǎn)[6]。目前臨床急需一種有效的治療方法，用于提高膝關(guān)節(jié)骨性關(guān)節(jié)炎患者的臨床治療效果，減少并發(fā)癥。關(guān)節(jié)鏡近年來(lái)用于治療膝關(guān)節(jié)相關(guān)疾病的效果十分顯著，具有微創(chuàng)、效果可靠等優(yōu)點(diǎn)，本研究旨在探討膝關(guān)節(jié)鏡治療癥狀性膝關(guān)節(jié)骨關(guān)節(jié)炎的臨床效果，現(xiàn)報(bào)道如下。