全膝关节置换术后关节镜清创治疗滑膜炎比治疗强直更有效

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-10-01 DOI:10.1016/j.asmr.2024.100965

Hussein Elkousy M.D. , Davin K. Fertitta B.S. , Laith Elkousy , Maudood Rana , Allyson N. Pfeil B.S. , Corey F. Hryc Ph.D.

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引用次数: 0

摘要

目的研究关节镜手术对全膝关节置换术（TKA）后强直和滑膜炎的影响，并将患者满意度作为主要结果衡量指标。方法使用《国际疾病分类》第九版和第十版修订版中的强直或滑膜炎代码以及《现行手术术语》代码 29884 和 29876，对 2002 年至 2024 年期间完成的所有膝关节镜手术进行查询。如果患者既往未进行过 TKA，或虽进行过 TKA 但因多种或其他适应症进行了关节镜检查，或距 TKA 术后 2 个月，或缺乏医疗记录，或属于工伤病例，则将其排除在外。患者被分为强直组和滑膜炎组。在首次和最后一次随访时收集了一份患者满意度调查表，要求患者将关节镜手术后的情况评为 "好转"、"不变 "或 "恶化"。共纳入了 199 名受试者：结果关节强直组和滑膜炎组的平均首次随访时间分别为 5.2 个月和 7.2 个月。最终平均随访时间分别为 3.7 年和 4.8 年。在最初的随访中，强直组好转了31%，不变了56%，恶化了13%，而滑膜炎组好转了69%，不变了29%，恶化了2%（P< .001）。结论TKA术后，关节镜手术可减轻强直或滑膜炎患者的症状并提高其满意度。与强直相比，滑膜炎患者的满意度提高的比例更大。

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Arthroscopic Debridement After Total Knee Arthroplasty Is More Effective for Synovitis Than for Ankylosis

Purpose

To investigate the effects of arthroscopy surgery on ankylosis and synovitis after total knee arthroplasty (TKA), with patient satisfaction as the main outcome measure.

Methods

A single surgeon’s database was queried for all knee arthroscopy procedures done from 2002 to 2024 using the International Classification of Diseases, Ninth and Tenth Revision, codes for ankylosis or synovitis and Current Procedural Terminology codes 29884 and 29876. Patients were excluded if they did not have a previous TKA, had a TKA but arthroscopy was done for multiple or other indications, were <2 months from TKA, lacked medical records, or were worker’s compensation cases. Patients were separated into either the ankylosis group or the synovitis group. A patient satisfaction survey was collected at first and last follow-up and asked individuals to rate their condition as “better,” “unchanged,” or “worse” after arthroscopy. A total of 199 subjects were included: 48 in the ankylosis group and 151 in the synovitis group.

Results

The mean initial follow-up time was 5.2 and 7.2 months for the ankylosis and synovitis groups, respectively. The mean final follow-up time was 3.7 and 4.8 years, respectively. For initial follow-up, the ankylosis group reported 31% better, 56% unchanged, and 13% worse, whereas the synovitis group reported 69% better, 29% unchanged, and 2% worse (P < .001). For final follow-up, the ankylosis group reported 44% better, 41% unchanged, and 15% worse, whereas the synovitis group reported 78% better, 10% unchanged, and 12% worse (P < .001).

Conclusions

After TKA, arthroscopic surgery can reduce symptoms and improve satisfaction for patients with ankylosis or synovitis. Patient satisfaction is improved in a greater percentage of patients with synovitis compared with ankylosis.