关节清理术

关节清理术,罗泽宇 四川大学华西医院骨科,背景,原理：膝OA磨损产生疼痛,2,炎性因子增加,背景,关节镜手术对韧带损伤或半月板修复效果明显，但是对OA患者的疗效不确切关节镜下冲洗、去除或修复软组织关节冲洗关节镜冲洗关节置管冲洗,3,1.Chang, R.W.arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum, 1993.,到底是关节镜的修复作用还是冲洗可以膝OA缓解疼痛,文献 1,4,Design：RCT 前瞻性随机双盲对照研究 Evidence: Level I 一级循证医学证据,1.Moseley. N Engl J Med, 2002,Inclusion criteria75 years old or younger KOA defined by the American College of Rheumatology Pain：4 on VASNo arthroscopy of the knee during the previous two years Exclusion criteriaseverity grade of 9 or higher (similar to Kellgren-Lawrence classification)severe deformityserious medical problems,Materials & Methods,Randomization Processstratified samplingGrade 1, 2, or 3; grade 4, 5, or 6; and grade 7 or 8 Treatment Groups Arthroscopic dbridement (59)lavaged with 10 liters of fluid rough articular cartilage was shaved chondroplasty was performed loose debris was removed meniscal fragments were trimmed bone spurs were not removed (except tibial spine area)Arthroscopic lavage alone (61)lavaged with at least 10 liters of fluid The placebo (60)three 1-cm incisions were made in the skin a standard arthroscopic dbridement procedure was simulated,Materials & Methods,Follow-up2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months, and 24 months primary end point PainKnee Specific Pain Scale (KSPS) created for this study Arthritis Impact Measurement Scales (AIMS2-P) 36-item Short-Form FunctionArthritis Impact Measurement Scales (AIMS2-WB)36-item Short-Form Physical Functioning Scale (PFS) (30m and a flight of stairs ),Materials & Methods,Results,Primary outcome (Pain) At no point did either arthroscopic-interventiongroup have greater pain relief than the placebo group,Results,Primary outcome (Function) at no time point did either arthroscopic-intervention group have significantly greater improvement in function than the placebo group,Conclusion,This study has also shown the great potential for a placebo effect with surgery, although it is unclear whether this effect is due solel