CAJ | 학술논문

目的：探讨应用关节镜检查评估单髁置换手术（UKA）指征的可行性和风险与收益评价。方法回顾性分析2012年1月至2014年3月，25例在杨浦医院关节外科拟行UKA治疗膝骨关节炎患者，因术前手术指征存疑的在术前行关节镜检查。观察检查准确性、手术时间和并发症，采用美国膝关节协会评分（KSS评分）对术后膝关节功能进行评估。结果25例关节镜检查时间平均7．3 min（5～10 min），关节镜检查后25例患者中7例（28％）更换手术方式。所有患者均获得了完整的随访，术后平均随访15个月（6～30个月），无感染、脂肪栓塞或下肢深静脉血栓形成，末次随访患者膝关节疼痛消失或明显减轻。术后KSS膝评分（92±7）分与术前（55±9）分比较有统计学差异（t＝20．73，P＜0．01）；术后KSS功能评分（92±8）分与术前（56±7）分比较有统计学差异（ t＝34．40，P＜0．01）。根据评分22例疗效优秀，3例良好，行关节置换患者在随访期内无假体磨损，松动，脱位和进展性骨关节炎等并发症。结论关节镜检查具有更高准确率，操作简单，且并不增加手术感染率和手术风险。在术前明确手术指征困难的患者中，关节镜检查相对术中直视下检查更具优势。
목적：탐토응용관절경검사평고단과치환수술（UKA）지정적가행성화풍험여수익평개。방법회고성분석2012년1월지2014년3월，25례재양포의원관절외과의행UKA치료슬골관절염환자，인술전수술지정존의적재술전행관절경검사。관찰검사준학성、수술시간화병발증，채용미국슬관절협회평분（KSS평분）대술후슬관절공능진행평고。결과25례관절경검사시간평균7．3 min（5～10 min），관절경검사후25례환자중7례（28％）경환수술방식。소유환자균획득료완정적수방，술후평균수방15개월（6～30개월），무감염、지방전새혹하지심정맥혈전형성，말차수방환자슬관절동통소실혹명현감경。술후KSS슬평분（92±7）분여술전（55±9）분비교유통계학차이（t＝20．73，P＜0．01）；술후KSS공능평분（92±8）분여술전（56±7）분비교유통계학차이（ t＝34．40，P＜0．01）。근거평분22례료효우수，3례량호，행관절치환환자재수방기내무가체마손，송동，탈위화진전성골관절염등병발증。결론관절경검사구유경고준학솔，조작간단，차병불증가수술감염솔화수술풍험。재술전명학수술지정곤난적환자중，관절경검사상대술중직시하검사경구우세。
Objective To evaluate the feasibility and risk-benefit of arthroscopy before unicompartmental knee arthroplasty (UKA).Methods Between January 2012 and December 2014, 25 patients who were doubted about the indications underwent arthroscopy before UKA in joint surgery department of Yangpu Hospital.The accuracy of the examination, surgical time and complications were observed and recorded.The pre-and post-operative functions of the knees were evaluated by American knee society score (KSS).Results The mean surgical time was 7.3 min (5 -10 min).Seven cases (28%) changed surgical option.All the cases were followed up for 15 months (6 -30 months) in average;none of them had complications of infection, fat embolism, deep vein thrombosis, malposition of prosthesis, dislocation or loosening.The postoperative KSS knee score ( 92 ±7 ) showed significant difference compared with the preoperative one (55 ±9) (t =20.73,P<0.01); the postoperative KSS function score ( 92 ±8 ) also showed significant difference compared with the preoperative one ( 56 ±7 ) (t=34.40,P<0.01).According to the KSS score, 22 cases were excellent, and three cases were good. At the last follow up, all the cases achieved significant relief of pain.Conclusion These results indicate that arthroscopy has excellent accuracy and will not increase the risks of infection or complication, which can be used in workup for the patients who are doubted about the indications before UKA.