關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較_《中國修復重建外科雜志》

作者：

劉暢 ^1,2 , 施新革 ¹ , 劉玉杰 ¹ , 王志剛 ¹ , 魏民 ¹

1 解放軍總醫院骨科（北京，100853）;;
2 滄州市中心醫院骨二科;

關鍵詞：

踝關節退行性骨關節病關節鏡非手術治療

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目的探討關節鏡手術與非手術方法治療踝關節退行性骨關節病的療效。方法選擇2009年7月－2011年6月收治并符合選擇標準的58例（58踝）踝關節退行性骨關節病患者納入研究。根據治療方法不同將患者分為兩組，其中28例行關節鏡手術（關節鏡組），30例行常規保守治療（對照組）。兩組性別、年齡、體重指數、病程及骨關節炎分度等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。手術前后參照Mazur等的功能評分、疼痛視覺模擬評分（VAS）和Tegner運動水平分級評定療效，并進行統計學分析。結果關節鏡組患者術后切口均Ⅰ期愈合。兩組患者均獲隨訪，隨訪時間1～2年，關節鏡組平均1.5年，對照組平均1.6年。末次隨訪時，兩組Mazur、VAS和Tegner評分均較術前顯著改善，差異有統計學意義（P lt; 0.05）；術后兩組間各評分比較，差異均無統計學意義（P gt; 0.05）。根據Mazur評分標準，關節鏡組獲優8例，良14例，可5例，差1例，優良率為79%；對照組獲優6例，良15例，可6例，差3例，優良率為70%；兩組比較差異無統計學意義（u=0.98，P=0.77）。關節鏡組Outerbridge分級與Mazur評分無相關性（r=0.18，P=0.34）。結論關節鏡手術及非手術方法治療踝關節退行性骨關節病均可獲得較好療效。

引用本文： 劉暢,施新革,劉玉杰,王志剛,魏民. 關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較. 中國修復重建外科雜志, 2012, 26(11): 1315-1318. doi: 復制

1.	1 Olson KM, Dairyko GH Jr, Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg (Am), 2011, 93(1): 66-72. 2 Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consectutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J, 2005, 25: 44-46.
2.	Loong TW, Mitra AK, Tan SK. Role of arthroscopy in ankle disorder—early experience. Ann Acad Med Singapore, 1994, 23(3): 348-350.
3.	王俊良, 劉玉杰, 李眾利, 等. 關節鏡監視下踝關節植骨融合術的療效分析. 中國骨傷, 2011, 24(9): 719-722.
4.	Brennan SA, Rahim F, Dowling J, et al. Arthroscopic debridement for soft tissue ankle impingement. Ir J Med Sci, 2012, 181(2): 253-256.
5.	Boc SF, Muscarella V. Clinics in Podiatric medicine and surgery. Prefact Clin Podiatr Med Surg. 2012, 29(1): XV-XVI.
6.	Harris TG, Lee D. Arthroscopic ankle arthrodesis after tibial pilon open reduction internal fixation. Foot Ankle Spec, 2011, 4(3): 188-193.
7.	Giannoudis PV. Practical procedures in elective orthopaedic surgery London: Springer, 2012, 5: 249-253.
8.	Ahlbäck S, Rydberg J. X-ray classification and examination technics in gonarthrosis. Lakartidningen, 1980, 77(22): 2091-2093, 2096.
9.	Moon JS, Shim JC, Suh JS, et al. Radiographic predictability of cartilage damage in medial ankle osteoarthritis. Clin Orthop Relat Res, 2010, 468(8): 2188-2197.
10.	Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg, 2009, 17(9): 591-600.
11.	Mazur JM, Schwartz E, Sheldon SR. Ankle arthrodesis: Long-term follow-up with gait analysis. J Bone Joint Surg (Am), 1979, 61(7): 964-975.
12.	Sun SF, Hsu CW, Sun HP, et al. The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg (Am), 2011, 93(18): 1720-1726.
13.	Migliore A, Giovannangeli F, Bizzi E, et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg, 2011, 131(1): 139-147.
14.	Salt RS, Chang TJ, D’Costa WF, et al. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg (Am), 2006, 88(2): 295-302.
15.	Hassouna H, Kumar S, Bendall S, et al. Arthroscopic ankle debridement: 5-year survival analysis. Acta Orthop Belg, 2007, 73(6): 737-740.
16.	Rose T, Lill H, Josten C. Arthroscopy for anterior joint pathology at the upper ankle joint—pathogenesis, therapy and results. Sportverletz Sportschaden, 2003, 17(4): 176-180.
17.	Lim HC, Bae JH, Song SH, et al. Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes. Clin Orthop Relat Res, 2012, 470(8): 2261-2267.

1. 1 Olson KM, Dairyko GH Jr, Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg (Am), 2011, 93(1): 66-72. 2 Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consectutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J, 2005, 25: 44-46.
2. Loong TW, Mitra AK, Tan SK. Role of arthroscopy in ankle disorder—early experience. Ann Acad Med Singapore, 1994, 23(3): 348-350.
3. 王俊良, 劉玉杰, 李眾利, 等. 關節鏡監視下踝關節植骨融合術的療效分析. 中國骨傷, 2011, 24(9): 719-722.
4. Brennan SA, Rahim F, Dowling J, et al. Arthroscopic debridement for soft tissue ankle impingement. Ir J Med Sci, 2012, 181(2): 253-256.
5. Boc SF, Muscarella V. Clinics in Podiatric medicine and surgery. Prefact Clin Podiatr Med Surg. 2012, 29(1): XV-XVI.
6. Harris TG, Lee D. Arthroscopic ankle arthrodesis after tibial pilon open reduction internal fixation. Foot Ankle Spec, 2011, 4(3): 188-193.
7. Giannoudis PV. Practical procedures in elective orthopaedic surgery London: Springer, 2012, 5: 249-253.
8. Ahlbäck S, Rydberg J. X-ray classification and examination technics in gonarthrosis. Lakartidningen, 1980, 77(22): 2091-2093, 2096.
9. Moon JS, Shim JC, Suh JS, et al. Radiographic predictability of cartilage damage in medial ankle osteoarthritis. Clin Orthop Relat Res, 2010, 468(8): 2188-2197.
10. Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg, 2009, 17(9): 591-600.
11. Mazur JM, Schwartz E, Sheldon SR. Ankle arthrodesis: Long-term follow-up with gait analysis. J Bone Joint Surg (Am), 1979, 61(7): 964-975.
12. Sun SF, Hsu CW, Sun HP, et al. The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg (Am), 2011, 93(18): 1720-1726.
13. Migliore A, Giovannangeli F, Bizzi E, et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg, 2011, 131(1): 139-147.
14. Salt RS, Chang TJ, D’Costa WF, et al. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg (Am), 2006, 88(2): 295-302.
15. Hassouna H, Kumar S, Bendall S, et al. Arthroscopic ankle debridement: 5-year survival analysis. Acta Orthop Belg, 2007, 73(6): 737-740.
16. Rose T, Lill H, Josten C. Arthroscopy for anterior joint pathology at the upper ankle joint—pathogenesis, therapy and results. Sportverletz Sportschaden, 2003, 17(4): 176-180.
17. Lim HC, Bae JH, Song SH, et al. Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes. Clin Orthop Relat Res, 2012, 470(8): 2261-2267.

《中國修復重建外科雜志》

關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較

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《中國修復重建外科雜志》

關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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