關(guān)節(jié)清理術(shù) ppt課件

1、關(guān)節(jié)清理術(shù),羅澤宇 四川大學(xué)華西醫(yī)院骨科,背景,原理：膝OA磨損產(chǎn)生疼痛,2,炎性因子增加,背景,關(guān)節(jié)鏡手術(shù)對(duì)韌帶損傷或半月板修復(fù)效果明顯，但是對(duì)OA患者的療效不確切關(guān)節(jié)鏡下沖洗、去除或修復(fù)軟組織關(guān)節(jié)沖洗關(guān)節(jié)鏡沖洗關(guān)節(jié)置管沖洗,3,1.Chang, R.W.arthroscopic surgery versus closed-needle joint lavage for patients with osteoart

2、hritis of the knee. Arthritis Rheum, 1993.,到底是關(guān)節(jié)鏡的修復(fù)作用還是沖洗可以膝OA緩解疼痛,文獻(xiàn) 1,4,Design：RCT – 前瞻性隨機(jī)雙盲對(duì)照研究 Evidence: Level I – 一級(jí)循證醫(yī)學(xué)證據(jù),1.Moseley. N Engl J Med, 2002,Inclusion criteria75 years old or younger KOA defined by

3、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 d

4、eformityserious medical problems,Materials & Methods,Randomization Processstratified samplingGrade 1, 2, or 3; grade 4, 5, or 6; and grade 7 or 8 Treatment Groups Arthroscopic débridement (59)lavaged with

5、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

6、 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 débridement procedure was simulated,Materials & Methods,Follow-up2 week

7、s, 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 Func

8、tionArthritis 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 arthro

9、scopic-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

10、 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 solely to the natural history of the condition or whet