全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2017 

关节镜下清理术联合 Ilizarov 牵伸术治疗膝关节骨关节炎近期疗效观察

DOI: doi:10.7507/1002-1892.201701099

Keywords: 膝关节骨关节炎, 关节牵伸术, 关节镜, Ilizarov 技术

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的 探讨关节镜下清理术联合 Ilizarov 牵伸术治疗膝关节骨关节炎(knee osteoarthritis,KOA)的近期疗效。 方法 2014 年 1 月—2015 年 1 月,采用关节镜下清理术联合 Ilizarov 牵伸术治疗 KOA 患者 15 例(15 膝)。其中男 7 例,女 8 例;年龄 45~64 岁,平均 55 岁。左膝 6 例,右膝 9 例。病程 2.0~9.5 年,中位病程 6 年。患者均经 6 个月保守治疗,临床症状无明显改善。术前疼痛视觉模拟评分(VAS)为(76.2±8.8)分,美国西部 Ontario 与 McMaster 大学骨关节炎指数评分(WOMAC)为(59.3±5.7)分,膝关节损伤和骨关节炎评定量表评分(KOOS)为(44.3±7.2)分,膝关节活动度(range of motion,ROM)为(75±21)°。X 线片测量关节间隙为(2.5±0.4)mm。根据 Kellgren-Lawrence 分级标准,Ⅲ 级 11 例、Ⅳ 级 4 例。 结果 术后切口均 Ⅰ 期愈合,外固定支架钉道无感染,无下肢深静脉血栓形成等相关并发症发生。患者均获随访,随访时间 12~18 个月,平均 15.5 个月。术后患者膝关节疼痛症状及关节活动明显改善,术后 12 个月 VAS 评分、WOMAC 评分、KOOS 评分分别为(20.9±7.8)、(38.2±5.5)、(92.1±6.9)分,膝关节 ROM 为(118±14)°,均优于术前,比较差异有统计学意义(t=18.213,P=0.000;t=10.317,P=0.000;t=18.564,P=0.000;t=6.599,P=0.000)。X 线片复查示,术后 12 个月关节间隙为(3.8±0.3)mm,与术前比较差异有统计学意义(t=10.070,P=0.000)。 结论 关节镜下清理术联合 Ilizarov 牵伸术治疗 KOA,可有效缓解关节疼痛,提高膝关节功能,利于软骨组织修复,延缓骨关节炎进展,近期疗效满意

References

[1]  4. Flouzat-Lachaniette CH, Roubineau F, Heyberger C, et al. Distraction to treat knee osteoarthritis. Joint Bone Spine, 2017, 84(2): 141-144.
[2]  7. Kirkley A, Birminghm TB, Litchfield RB, et al. A randomized trial of artroscopic surgery for osteoarthritis of the knee. N Ensl J Med, 2008, 359: 1097-1107.
[3]  21. Wiegant K, Intema F, van Roermund PM, et al. Evidence of cartilage repair by joint distraction in a canine model of osteoarthritis. Arthritis Rheumatol, 2015, 67(2): 465-474.
[4]  23. Intema F, Van Roermund PM, Marijnissen AC, et al. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis, 2011, 70(8): 1441-1446.
[5]  24. Wiegant K, van Roermund PM, Intema F, et al. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthritis Cartilage, 2013, 21(11): 1660-1667.
[6]  25. Khademi-Kalantari K, Mahmoodi Aghdam S, Akbarzadeh Baghban A, et al. Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis. J Bodyw Mov Ther, 2014, 18(4): 533-539.
[7]  26. Laroche D, Morisset C, Fortunet C, et al. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results. Knee, 2014, 21(3): 710-716.
[8]  27. van der Woude JA, Wieqant K, van Heerwaarden RJ, et al. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 876-886.
[9]  28. Xing L, Jiang Y, Gui J, et al. Microfracture combined with osteochondral paste implantation was more effective than microfracture alone for full-thickness cartilage repair. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8): 1770-1776.
[10]  5. Kinds MB, Welsing PM, Vignon EP, et al. A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee. Osteoarthritis Cartilage, 2011, 19(7): 768-778.
[11]  8. Chen Y, Sun Y, Pan X, et al. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage, 2015, 23(10): 1728-1735.
[12]  9. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
[13]  10. 中华医学会骨科分会. 预防骨科大手术深静脉血栓形成指南(草案). 中华骨科杂志, 2007, 27(10): 790-792.
[14]  11. 杜健, 杨蕊菲, 隋磊, 等. 关节镜辅助 Ilizarov 牵张技术治疗踝关节创伤性骨关节炎疗效观察. 中国修复重建外科杂志, 2016, 30(2): 161-164.
[15]  12. Jang KW, Ding L, Seol D, et al. Low-intensity pulsed ultrasound promotes chondrogenic progenitor cell migration via focal adhesion kinase pathway. Ultrasound Med Biol, 2014, 40(6): 1177-1186.
[16]  13. Vinardell T, Rolfe RA, Buckley CT, et al. Hydrostatic pressure acts to stabilise a chondrogenic phenotype in porcine joint tissue derived stem cells. Eur Cell Mater, 2012, 23: 121-132.
[17]  15. Saito T, Nishida K, Furumatsu T, et al. Histone deacetylase inhibitors suppress mechanical stress-induced expression of RUNX-2 and ADAMTS-5 through the inhibition of the MAPK signaling pathway in cultured human chondrocytes. Osteoarthritis Cartilage, 2013, 21(1): 165-174.
[18]  16. Beier F, Loeser RF. Biology and Pathology of Rho GTPase, PI-3 Kinase-Akt, and MAP Kinase Signaling Pathways in Chondrocytes. J Cell Biochem, 2010, 110(3): 573-580.
[19]  17. Takebe K, Nishiyama T, Hayashi S, et al. Regulation of p38 MAPK phosphorylation inhibits chondrocyte apoptosis in response to heat stress or mechanical stress. Int J Mol Med, 2011, 27(3): 329-335.
[20]  18. Lu Y, Xu Y, Yin Z, et al. Chondrocyte migration affects tissue-engineered cartilage integration by activating the signal transduction pathways involving Src, PLCy1, and ERK1/2. Tissue Eng Part A, 2013, 19(21-22): 2506-2516.
[21]  19. Grad S, Eglin D, Alini M, et al. Physical stimulation of chondrogenic cells in vitro: a review. Clin Orthop Relat Res, 2011, 469(10): 2764-2772.
[22]  1. Cooper C, Adachi JD, Bardin T, et al. How to define responders in osteoarthritis. Curr Med Res Opin, 2013, 29(6): 719-729.
[23]  2. Robinson WH, Lepus CM, Wang Q, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol, 2016, 12(10): 580-592.
[24]  3. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet, 2011, 377(9783): 2115-2126.
[25]  6. Lohmander LS, Roos EM. Clinical update: treating osteoarthritis. Lancet, 2007, 370(9605): 2082-2084.
[26]  14. Nebelung S, Gavenis K, Lüring C, et al. Simultaneous anabolic and catabolic responses of human chondrocytes seeded in collagen hydrogels to long-term continuous dynamic compression. Ann Anat, 2012, 194(4): 351-358.
[27]  20. Jeon JE, Schrobback K, Hutmacher DW, et al. Dynamic compression improves biosynthesis of human zonal chondrocytes from osteoarthritis patients. Osteoarthritis Cartilage, 2012, 20(8): 906-915.
[28]  22. Baboolal TG, Mastbergen SC, Jones E, et al. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing tocartilage repair in osteoarthritis using knee joint distraction. Ann Rheum Dis, 2016, 75(5): 908-915.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133