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(yī)院骨科（北京，100853）;;
  • 2 滄州市中心醫(yī)院骨二科;

目的 探討關(guān)節(jié)鏡手術(shù)與非手術(shù)方法治療踝關(guān)節(jié)退行性骨關(guān)節(jié)病的療效。 方法選擇2009年7月－2011年6月收治并符合選擇標(biāo)準(zhǔn)的58例（58踝）踝關(guān)節(jié)退行性骨關(guān)節(jié)病患者納入研究。根據(jù)治療方法不同將患者分為兩組，其中28例行關(guān)節(jié)鏡手術(shù)（關(guān)節(jié)鏡組），30例行常規(guī)保守治療（對照組）。兩組性別、年齡、體重指數(shù)、病程及骨關(guān)節(jié)炎分度等一般資料比較，差異均無統(tǒng)計學(xué)意義（P  gt; 0.05），具有可比性。手術(shù)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(jìn)行統(tǒng)計學(xué)分析。 結(jié)果關(guān)節(jié)鏡組患者術(shù)后切口均Ⅰ期愈合。兩組患者均獲隨訪，隨訪時間1～2年，關(guān)節(jié)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(shù)前顯著改善，差異有統(tǒng)計學(xué)意義（P  lt; 0.05）；術(shù)后兩組間各評分比較，差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）。根據(jù)Mazur評分標(biāo)準(zhǔn)，關(guān)節(jié)鏡組獲優(yōu)8例，良14例，可5例，差1例，優(yōu)良率為79%；對照組獲優(yōu)6例，良15例，可6例，差3例，優(yōu)良率為70%；兩組比較差異無統(tǒng)計學(xué)意義（u=0.98，P=0.77）。 關(guān)節(jié)鏡組Outerbridge分級與Mazur評分無相關(guān)性（r=0.18，P=0.34）。 結(jié)論關(guān)節(jié)鏡手術(shù)及非手術(shù)方法治療踝關(guān)節(jié)退行性骨關(guān)節(jié)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(guān)節(jié)鏡手術(shù)與非手術(shù)治療踝關(guān)節(jié)退行性骨關(guān)節(jié)病的療效比較. 中國修復(fù)重建外科雜志, 2012, 26(11): 1315-1318. doi: 復(fù)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(guān)節(jié)鏡監(jiān)視下踝關(guān)節(jié)植骨融合術(shù)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. 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. 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. 3. 王俊良, 劉玉杰, 李眾利, 等. 關(guān)節(jié)鏡監(jiān)視下踝關(guān)節(jié)植骨融合術(shù)的療效分析. 中國骨傷, 2011, 24(9): 719-722.
  4. 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. 5. Boc SF, Muscarella V. Clinics in Podiatric medicine and surgery. Prefact Clin Podiatr Med Surg. 2012, 29(1): XV-XVI.
  6. 6. Harris TG, Lee D. Arthroscopic ankle arthrodesis after tibial pilon open reduction internal fixation. Foot Ankle Spec, 2011, 4(3): 188-193.
  7. 7. Giannoudis PV. Practical procedures in elective orthopaedic surgery London: Springer, 2012, 5: 249-253.
  8. 8. Ahlbäck S, Rydberg J. X-ray classification and examination technics in gonarthrosis. Lakartidningen, 1980, 77(22): 2091-2093, 2096.
  9. 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. 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. 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. 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. 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. 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. 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. 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. 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.