踏腳石 - 退化性膝關節炎患者的棲息地

Introduction: Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented.

Materials and methods: In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study.

Results: All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups.

Conclusions: MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.

內側摩擦症候群：一個被忽視的膝關節置換術後不明疼痛原因

作者：呂紹睿  許家禎  洪榮斌

中文摘要

簡介：膝關節置換後，持續性的不明原因疼痛常讓原本成功的手術大打折扣。本研究將探討「內側摩擦症候群」是造成這問題的原因之一。本篇報告，不但詳細說明將這觀念運用在人工膝關節置換手術以及使用關節鏡內側放鬆術治療置換後發生不明原因疼痛患者的手術技術，也將呈現我們的治療成效。  

對象及方法：在一年的期間，共有150位病患的196個患有重度骨性關節炎的膝關節接受我們合併處理「內側摩擦現象」的人工膝關節置換手術（包括全置換以及部分置換）。相同期間，有16位病患的16個已經接受關節置換的膝關節由他院轉來，接受關節鏡內側放鬆手術，治療他們持續性的不明原因疼痛。我們運用主觀滿意度，膝關節協會評分法（KSS），以及膝外傷及骨性關節炎評分法（KOOS）進行治療成效分析。

結果：所有166位病患均完成至少三年的療效追蹤評估（3.1-4.2年，平均3.7年）。所有接受關節置換的患者，均發現有內側皺襞引起的「內側摩擦現象」。在接受我們合併移除「內側摩擦現象」的關節置換手術後，只有兩個膝關節產生持續性疼痛：其一是部分置換的關節發生脛骨平台骨折，另一則是全置換的關節合併細菌感染。整體滿意度，在部分置換這組是98.8%，全置換這組是99.1%，因術後不明原因疼痛轉院求診，接受關節鏡內側放鬆手術的這組是100%。而且，各組在膝關節協會評分法（KSS）以及膝外傷及骨性關節炎評分法（KOOS）均有統計學上有意義的明顯改善。

結論：「內側摩擦現象」引起的「內側摩擦症候群」是骨性膝關節炎患者膝痛的重要原因，在執行人工關節置換手術時，應該要一併處理。接受膝關節置換後的不明原因持續性疼痛，「內側摩擦症候群」是被忽略的重要原因，可以使用關節鏡內側放鬆手術治癒。
相較於本篇論文98.8％以及99.1％的滿意度，文獻相關報導，在接受人工膝關節置換後，有30-40%的病患是不滿意的。箇中的差異，就在是否有重視內側皺襞引起的「內側摩擦現象」！
本中心執行的膝關節整形手術（包括骨矯正、微重建、全置換），都會精確地一併處理疼痛病因，統稱為「精準膝關節重建手術」。

期待，這個小小的發現，能啟發更多專業醫師，造福病患。

          
完整原文下載連結：
Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty