半月板撕裂和骨关节炎的手术治疗与物理治疗比较

骨科医师之家  2013年8月30日  阅读数:1264  字体:    

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis

半月板撕裂和骨关节炎的手术治疗与物理治疗比较

(编者按)半月板撕裂是体育运动中非常常见的一种运动创伤,往往由于关节活动的不协调,导致半月板卡在股骨和胫骨间,引起撕裂。骨关节炎是一种慢性关节疾病,其主要改变是关节软骨退行性病及继发性骨质增生。Jeffrey N. Katz等人研究发现目前为止对于半月板撕裂和骨关节炎患者而言,手术治疗和物理治疗没有显著差距,且意向分析及WOMAC评分表明这两种治疗方案的不良反应无显著差异。

原文链接: http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

Background

背景

Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain.

对于有半月板撕裂和膝骨关节炎症状的患者而言,关节镜下部分半月板切除术是否比非手术治疗的功能疗效更好,还不确定。

Methods

方法

We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization.

我们进行了多中心、随机、对照临床试验,该试验入选了一批以45岁以上(包括45岁)有临床症状的患者,他们有半月板撕裂和轻中度骨关节炎(有影像学的证据显示)的症状。我们随机分配351例患者进行手术及术后的物理治疗,或者采取标准化的理疗方案(由患者和外科医生一起权衡并做出选择,直到不得不手术之前)。我们在第6和第12个月对患者进行了评估。在临床随机试验分组后的6个月,初步的研究结果表明:我们应用了西安大略大学和麦克马斯特大学骨关节炎指数(WOMAC)物理功能得分(取值范围从0100,数值越高,表示症状越严重)的变化进行评价,两组之间是有差异的。

Results

结果

In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, 1.8 to 6.5). At 6 months, 51 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months. The frequency of adverse events did not differ significantly between the groups.

在意向治疗分析中,6个月后手术组的WOMAC评分平均提高了20.9分(95%可信区间[CI],为17.923.9),而物理治疗组平均提高了18.5分(95CI,为15.621.5),两者评分的平均差为2.4分;95%CI平均差为-1.86.5。第6个月时,被单独分配到物理治疗组的51名积极参与研究的患者(占30%)进行了手术,而9名分配到手术组(占6%)的患者还未接受手术。第12个月的结果与第6个月的类似。两组之间,不良反应的出现频率没有显著差异。

Conclusions

结论

In the intention-to-treat analysis, we did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months.

通过意向治疗分析,我们发现,在随机化分组6个月后,两个研究组之间的功能改善没有明显差异。然而,被单独分配到物理治疗组的患者的30%在六个月内接受了手术。

 

 

责任编辑:陈烨 马黎 李锡海