CAJ | 학술논문

目的总结关节镜在膝关节单髁置换术中的意义。方法2010年3月至2012年5月，我院为31例膝(33个膝)关节内侧间室骨关节炎患者，行单髁置换中的常规关节镜探查清理。对比其术前查体、影像学检查、术中情况及术后结果，分析关节镜在单髁置换术中的应用价值。结果通过镜检发现所有患者病变主要位于内侧室，内侧室关节面软骨呈现 Outerbrige III～IV 度退变，外侧室关节面软骨正常或退变＜Outerbrige II度(5个膝关节外侧室关节面软骨退变Outerbrige I～II度)。24个膝关节存在不同程度的内侧半月板损伤及退变，10个膝关节合并Outerbrige I～II度髌股软骨退变，6个膝关节合并外侧半月板损伤及退变，1个膝合并前交叉韧带后外束部分断裂，患者改行全膝置换术。HSS评分：术前平均(67.56±2.929)分，术后平均(90.22±3.816)分，差异有统计学意义( t＝24.992，P＜0.05)；膝关节屈曲度：术前平均(103.16±6.802)°，术后平均(114.75±4.765)°，差异有统计学意义( t＝11.666，P＜0.05)；负重位膝内翻角：术前平均(12.16±2.102)°，术后平均(8.75±2.015)°，差异有统计学意义( t＝17.646，P＜0.05)；屈曲挛缩：术前平均(11.36±1.902)°，术后平均(6.75±2.632)°，差异有统计学意义( t＝16.036，P＜0.05)；关节镜探查清理时间平均(9.54±2.019) min。结论(1)尽管关节镜探查延长了手术时间，但在筛选手术适应证方面具有更严谨的作用；(2)对于选择单髁置换合并其它间室病变的患者，关节镜是一种必不可少的治疗手段；(3)对于术前影像学检查及查体提示合并其它间室病变的患者，关节镜探查清理应是单髁置换前的常规步骤。
목적총결관절경재슬관절단과치환술중적의의。방법2010년3월지2012년5월，아원위31례슬(33개슬)관절내측간실골관절염환자，행단과치환중적상규관절경탐사청리。대비기술전사체、영상학검사、술중정황급술후결과，분석관절경재단과치환술중적응용개치。결과통과경검발현소유환자병변주요위우내측실，내측실관절면연골정현 Outerbrige III～IV 도퇴변，외측실관절면연골정상혹퇴변＜Outerbrige II도(5개슬관절외측실관절면연골퇴변Outerbrige I～II도)。24개슬관절존재불동정도적내측반월판손상급퇴변，10개슬관절합병Outerbrige I～II도빈고연골퇴변，6개슬관절합병외측반월판손상급퇴변，1개슬합병전교차인대후외속부분단렬，환자개행전슬치환술。HSS평분：술전평균(67.56±2.929)분，술후평균(90.22±3.816)분，차이유통계학의의( t＝24.992，P＜0.05)；슬관절굴곡도：술전평균(103.16±6.802)°，술후평균(114.75±4.765)°，차이유통계학의의( t＝11.666，P＜0.05)；부중위슬내번각：술전평균(12.16±2.102)°，술후평균(8.75±2.015)°，차이유통계학의의( t＝17.646，P＜0.05)；굴곡련축：술전평균(11.36±1.902)°，술후평균(6.75±2.632)°，차이유통계학의의( t＝16.036，P＜0.05)；관절경탐사청리시간평균(9.54±2.019) min。결론(1)진관관절경탐사연장료수술시간，단재사선수술괄응증방면구유경엄근적작용；(2)대우선택단과치환합병기타간실병변적환자，관절경시일충필불가소적치료수단；(3)대우술전영상학검사급사체제시합병기타간실병변적환자，관절경탐사청리응시단과치환전적상규보취。
Objective To investigate the application of the arthroscope in unicompartmental knee arthroplasty ( UKA ). Methods From March 2010 to May 2012, 31 patients ( 33 knees ) with medial compartment osteoarthritis who were scheduled to undergo UKA were treated by conventionally arthroscopic debridement. Based on the preoperative examination, imaging studies, intraoperative conditions and postoperative results, the application value of the arthroscope in UKA was analyzed. Results The arthroscopy showed that the lesions were mainly located in the medial compartment of the knee. The medial articular cartilage degeneration ( Outerbrige III-IV ) was found. The lateral articular cartilage was normal or presented degeneration (<Outerbrige II ), and degeneration ( Outerbrige I-II ) existed in 5 knees. Medial meniscus injuries and degeneration in different degrees was found in 24 knees, patellofemoral cartilage degeneration ( Outerbrige I-II ) in 10 knees and lateral meniscus injuries and degeneration in 6 knees. The posterolateral bundle ( PLB ) of the anterior cruciate ligament ( ACL ) was partly ruptured in 1 knee, and the patient underwent total knee arthroplasty ( TKA ) instead. According to the Hospital for Special Surgery Knee Scoring System ( HSS ), the mean scores were ( 67.56±2.929 ) points preoperatively and ( 90.22±3.816 ) points postoperatively, and the differences were statistically signiifcant ( t=24.992, P<0.05 ). The mean range of knee lfexion was ( 103.16±6.802 ) ° preoperatively and ( 114.75±4.765 ) ° postoperatively, and the differences were statistically significant ( t=11.666, P<0.05 ). The mean knee varus angle in the weight-bearing position was ( 12.16±2.102 ) ° preoperatively and ( 8.75±2.015 ) ° postoperatively, and the differences were statistically significant ( t=17.646, P<0.05 ). The mean lfexion contracture was ( 11.36±1.902 ) ° preoperatively and ( 6.75±2.632 ) ° postoperatively, and the differences were statistically significant ( t=16.036, P<0.05 ). The mean time of arthroscopic debridement was ( 9.54±2.019 ) min.Conclusions ( 1 ) Although longer operation time is needed due to the arthroscopy, it is more rigorous in selecting surgical indications;( 2 ) Arthroscopy is an essential method for the patients treated by UKA and with lesions in other compartments;( 3 ) For the patients with lesions in other compartments indicated by the preoperative imaging studies and examinations, arthroscopic debridement should be a routine step before UKA.