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Title: [Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis].
Author: Dong P, Tang X, Wang J, Jiang Y, Yao W, Gui J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Jul 15; 31(7):794-798. PubMed ID: 29798521.
Abstract:
OBJECTIVE: To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). METHODS: Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. RESULTS: There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones ( t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one ( t=10.070, P=0.000). CONCLUSION: Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory. 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。.

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