201007152050ACRFP 已正式被國際學術界認可

將於今年九月在西班牙巴塞隆納舉辦的

第九屆國際軟骨修復學會 (International Cartilage Repair Society, ICRS 2010)   接受了有關 ACRFP 的論文發表

ACRFP(關節鏡軟骨再生促進手術), 這我已使用近四年的創新名詞終於被國際學術界認可,將有機會在國際曝光了!


Arthroscopic Cartilage Regeneration Facilitating Procedure (ACRFP) for OA Knee

Shaw-Ruey Lyu, MD, PhD
Joint Center
Tzu-Chi Dalin General Hospital, Chiayi, Taiwan

Abstract

Introduction: A novel concept of arthroscopic procedure for the treatment of osteoarthritic (OA) knee was developed based on the conceptualization of a possible pathogenesis process for OA knee featured by focal abrasion phenomenon and soft tissue imbalance.

Materials and Methods: From January to December 2005, 571 knees of 367 patients with OA knee have received this procedure. We used Kellgren-Lawrence classification for pre-operative staging. Pain domain of Knee Society Score (KSS-P) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for subjective outcome study. Measurement for the roentgenographic changes of femoral-tibial angle (FTA) and joint space width (JSW) was evaluated for objective outcome study. The mean follow-up period was 38 months (range, 36 to 49).

Results: There were 70 (19%) male and 297 (81%) female and the mean age was 60 years (range, 29 to 82). One hundred and thirty-four knees returned and completed the thorough outcome evaluation. Another 381 knees completed the subjective outcome evaluation by telephone questionnaires. The total follow-up rate was 90.2%. The satisfactory rate for the whole series was 85.5%. The FTA improved from 1.52 (95% confidence interval, 0.84~2.19) to 1.93 (1.21~2.64)(p=0.03). The JSW increased from 2.03 (2.81~3.24) to 2.18 (2.97~3.38)(p=0.01).

Conclusion: Arthroscopic cartilage regeneration facilitating procedure is a good option of treatment for OA knee. The beneficial effects of this procedure might be the improvement of the general environment of the knee joint for cartilaginous regeneration after eradication of the possible etiologic factors.


中文簡要:

2005 年,共有 367 位病患的 571 個膝關節因退化性膝關節炎在本中心接受關節鏡軟骨再生促進手術 (ACRFP)

平均追蹤 38 個月,整體滿意度為 85.5%,客觀的放射線檢查,無論是角度、關節間隙,均有統計學意義的改善


事實上,2003 是我第一次在 ICRS 發表對「退化性膝關節炎」致病機轉的新發現【見:最後一塊拼圖 (16): 大自然的啟示

轉眼間,七年時光已逝,主流學者仍絡繹不絕的擠進修復被不明原因破壞的軟骨的熱門研究路線,

而我,選擇了人煙稀少的路,企圖自源頭阻斷軟骨的破損,

不自覺,已穿越無數晦暗幽谷,柳暗花明的一刻,似乎已近 .......

此情此景,讓我憶起學生時期喜歡的一首愛爾蘭民歌:

Bushes and Briars

Through bushes and briars,

I lately found my way,

All for to hear the small birds sing,

And the lambs to skip and play ........

 

何謂「關節鏡軟骨再生促進手術」?

我們在 2000 年所創,針對治療「內側摩擦現象」的「關節鏡內側放鬆術」的臨床療效促使我們相信,經由清除因纖維化而變厚實的內側皺襞相關組織以消除「內側摩擦現象」,可以減輕大多數病人的疼痛,也會因此減緩或阻止部分患者膝關節的「退化」過程。因此,在 2005 年,我們提出了一項全新的手術概念:「關節鏡軟骨再生促進手術」(Arthroscopic Cartilage Regeneration Facilitating Procedure, ACRFP),成為以關節鏡治療「退化」性膝關節炎的整合型手術方式,它結合了「關節鏡內側放鬆術」(AMR)、「滑膜切除術」(Synovectomy)、「軟骨成形術」(Chondroplasty)、「部分半月板切除術」(Partial Meniscectomy)以及「經皮外側放鬆術」(Percutaneous Lateral Release, PLR)的各種組合。在以關節鏡詳細檢查後,視個別膝關節的不同狀況執行不同組合的手術,目標是藉由消除包括「內側摩擦現象」、局部或整體性滑膜炎、軟骨碎片、破損半月軟骨或外側壓迫現象等有害因素,並調整軟骨之間的壓力,提供受損軟骨一個適合再生的環境。

「關節鏡軟骨再生促進手術」的治療理論基礎是明確而經過實際驗證的,它的主要治療目標是:

1.移除任何膝關節內的異常摩擦(如軟骨碎片)或夾擊現象(如發炎腫脹變厚的滑膜囊)。

2.調節並釋放各關節面之間因軟組織長期反覆發炎所引起的過度張力,以解除關節面軟骨承受的不當壓力。

3.清除膝關節內所有會引起軟骨崩解的肥厚發炎滑膜囊。

若能確實執行這項手術,可整體改善膝關節內部的環境,為軟骨自然修復提供有利的環境。

遵循這些原則執行手術的經驗,加上影像學及臨床治療效果的長期追蹤,可以肯定的下這結論:對於「退化」性膝關節炎,「關節鏡軟骨再生促進手術」是一項有效的治療方式,它可以改善這一常見疾病的病程。若能徹底清除所有膝關節腔內的分解代謝因素,受損軟骨的合成代謝路徑可變為顯性而逐漸展現再生及修復的預期結果。

回應
關節中心入口網站
    沒有新回應!
累積 | 今日
loading......
關鍵字