内侧摩擦症候群：被忽视的膝关节置换后不明疼痛原因
2020的最后一天，这篇与内侧皱襞引起的「内侧摩擦现象」相关的重要论文，在历经整整一年，四次投稿，终于被接受了！
Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty
Shaw-Ruey Lyu, Chia-Chen Hsu and Jung-Pin Hung
Abstract
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.
内侧摩擦症候群：一个被忽视的膝关节置换术后不明疼痛原因
作者：吕绍睿 许家祯 洪荣斌
中文摘要
简介：膝关节置换后，持续性的不明原因疼痛常让原本成功的手术大打折扣。本研究将探讨「内侧摩擦症候群」是造成这问题的原因之一。本篇报告，不但详细说明将这观念运用在人工膝关节置换手术以及使用关节镜内侧放松术治疗置换后发生不明原因疼痛患者的手术技术，也将呈现我们的治疗成效。
对象及方法：在一年的期间，共有150位病患的196个患有重度骨性关节炎的膝关节接受我们合并处理「内侧摩擦现象」的人工膝关节置换手术（包括全置换以及部分置换）。相同期间，有16位病患的16个已经接受关节置换的膝关节由他院转来，接受关节镜内侧放松手术，治疗他们持续性的不明原因疼痛。我们运用主观满意度，膝关节协会评分法（KSS），以及膝外伤及骨性关节炎评分法（KOOS）进行治疗成效分析。
结果：所有166位病患均完成至少三年的疗效追踪评估（3.1-4.2年，平均3.7年）。所有接受关节置换的患者，均发现有内侧皱襞引起的「内侧摩擦现象」。在接受我们合并移除「内侧摩擦现象」的关节置换手术后，只有两个膝关节产生持续性疼痛：其一是部分置换的关节发生胫骨平台骨折，另一则是全置换的关节合并细菌感染。整体满意度，在部分置换这组是98.8%，全置换这组是99.1%，因术后不明原因疼痛转院求诊，接受关节镜内侧放松手术的这组是100%。而且，各组在膝关节协会评分法（KSS）以及膝外伤及骨性关节炎评分法（KOOS）均有统计学上有意义的明显改善。
结论：「内侧摩擦现象」引起的「内侧摩擦症候群」是骨性膝关节炎患者膝痛的重要原因，在执行人工关节置换手术时，应该要一并处理。接受膝关节置换后的不明原因持续性疼痛，「内侧摩擦症候群」是被忽略的重要原因，可以使用关节镜内侧放松手术治愈。
相较于本篇论文98.8％以及99.1％的满意度，文献相关报导，在接受人工膝关节置换后，有30-40%的病患是不满意的。个中的差异，就在是否有重视内侧皱襞引起的「内侧摩擦现象」！
期待，这个小小的发现，能启发更多专业医师，造福病患。
完整原文下载连结：
Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty