早期手术与物理治疗对非阻塞性半月经撕裂患者膝关节功能的影响:ESCAPE随机临床试验
Victor A van de Graaf1, Julia C A Noorduyn1, Nienke W Willigenburg1
1Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, the Netherlands.
JAMA
|October 5, 2018
概括
在非阻塞性半径撕裂的患者中,物理治疗与关节镜部分半径切除术 (APM) 一样有效. 这项研究表明PT是手术的可行替代方案, 在24个月内提供可比结果.
科学领域:
- 整形医学
- 运动医学
- 康复工作
背景情况:
- 尽管有证据表明它可能不优于物理治疗 (PT),但对半径撕裂经常进行关节镜部分半径切除术 (APM).
- 有必要比较非手术干预的疗效与月经膜撕裂的手术.
研究的目的:
- 为了确定物理治疗 (PT) 是否在改善患者报告的膝关节功能方面不低于关节镜部分脑膜切除术 (APM).
- 在非阻塞性半月膜撕裂的患者中评估24个月的膝关节功能结果.
主要方法:
- 一个多中心的随机临床试验,涉及321名年龄在45至70岁之间的非阻塞性半径撕裂患者.
- 在8周的时间内,参与者被分配到APM或16次PT方案中.
- 主要结果是使用国际膝关节文档委员会主观膝关节表在24个月内测量.
主要成果:
- 在APM和PT组中,膝盖功能均有所改善. APM增长了26.2个点,PT增长了20.4个点.
- 物理疗法 (PT) 发现与关节镜部分脑膜切除术 (APM) 不相差,组间差异为3. 6分 (97. 5% CI, - ∞至6. 5; P=. 001).
- 在APM组中,不良事件略高,包括重复手术和额外的门诊.
结论:
- 物理治疗 (PT) 是非阻塞性半径撕裂的患者与关节镜部分半径切除 (APM) 相比的非劣质治疗选择.
- 在24个月的随访期间,PT可以被认为是手术的合适替代品,提供可比的功能改善.
- 这些发现支持对非阻塞性半径撕裂进行保守的治疗.
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