[1]马开好 苟凌云△ 郭海 沈黎明 钟伟华 朱勇 杨新绿.三种微创术式治疗内侧型膝骨关节炎的疗效比较[J].中国中医骨伤科杂志,2020,28(06):10-15.
　MA Kaihao GOU Lingyun GUO Hai SHEN LimingZHONG Weihua ZHU Yong YANG Xinlu.Comparison of Three Minimally Invasive Surgical Procedures onMedial Knee Osteoarthritis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(06):10-15.
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三种微创术式治疗内侧型膝骨关节炎的疗效比较()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年06期
页码:
10-15
栏目:
临床研究
出版日期:
2020-06-10

文章信息/Info

Title:
Comparison of Three Minimally Invasive Surgical Procedures onMedial Knee Osteoarthritis
文章编号:
1005-0205(2020)06-0010-06
作者:
马开好1 苟凌云1△ 郭海1 沈黎明1 钟伟华1 朱勇1 杨新绿1
1广西柳州市中医医院创伤关节骨科二病区(广西 柳州,545001)
Author(s):
MA Kaihao1 GOU Lingyun1△ GUO Hai1 SHEN Liming1ZHONG Weihua1 ZHU Yong1 YANG Xinlu1
1Ward Ⅱ,Department of Traumatic and Joint Orthopedics,Liuzhou Hospital of Chinese Medicine,Liuzhou 545001,Guangxi China.
关键词:
微创手术;  腓骨近端截骨术;  关节镜清理术;  内侧型膝骨关节炎;  回顾性研究
Keywords:
minimally invasive surgery;  proximal fibula osteotomy;  arthroscopy debridement;  medial knee osteoarthritis;  retrospective study
分类号:
R684.3
文献标志码:
A
摘要:
目的:回顾性研究三种不同微创术式治疗内侧型膝骨关节炎(KOA)的临床疗效及对膝关节力线的影响。方法:按采用的术式将纳入的176例内侧型KOA患者分为腓骨近端截骨术组(A组)59例、腓骨近端截骨术+关节镜清理术组(B组)49例和关节镜清理术组(C组)68例,比较各组术后不同时间点患膝活动度(ROM)、美国纽约特种外科医院评分(HSS)、生活质量评分(SF-36)、疼痛视觉模拟评分(VAS)、胫骨平台内翻角、内外间隙比及并发症情况。结果:术后平均随访3.89年(2.0～5.9年)。术后3个月B,C组ROM,VAS,HSS,SF-36评分较A组差异有统计学意义(P<0.01),胫骨平台内翻角、内外间隙比差异无统计学意义(P>0.05); 术后1年A组和B组ROM,VAS,HSS,SF-36评分较术前改善,且较C组差异有统计学意义(P<0.05),胫骨平台内翻角、内外间隙比差异无统计学意义(P>0.05); 术后2年A组和B组ROM,VAS,HSS,SF-36评分较术前改善,且较C组差异有统计学意义(P<0.01),A组和B组间比较差异无统计学意义(P>0.05),胫骨平台内翻角、内外间隙比较C组差异有统计学意义(P<0.05)。治疗期间27例出现局部肿胀,经对症处理后在1个月内消退; A组和B组各出现4例和3例足背麻木感和感觉减退,给予对症治疗3～6个月后恢复。结论:关节镜清理术和关节镜清理术+膝关节近端截骨术治疗内侧型KOA早期疗效显著; 腓骨近端截骨术和腓骨近端截骨术+关节镜清理术治疗较单纯关节镜清理在早期、中期都取得较为满意的疗效,腓骨截骨术还能部分调整膝关节力线,减轻患者膝关节内侧疼痛感,改善膝关节功能,得到较好的中期临床疗效,提高了患者生活质量,在临床上应结合患者病情不同阶段灵活应用。
Abstract:
Objective:To retrospectively study the clinical efficacy of three different minimally invasive surgical procedures in treating medial knee osteoarthritis(KOA)and the effect on the knee joint line of force.Methods:According to the measures of treatment,176 patients with medial KOA were divided into the proximal fibula osteotomy group(group A)with 59 cases,the proximal fibula osteotomy + arthroscopy group(group B)with 49 cases and arthroscopic debridement group(group C)with 68 cases.The knee range(Range of Motion,ROM),Hospital for Special Surgery of New York(HSS),Quality of Life Score(Short Form 36 Questionnaire(SF-36)),Visual Analogue Scale(VAS)of pain,tibial plateau varus angle,internal and external space ratio and complications were documented and compared at different time points in each group.Results:The average follow-up was 3.89(2.0～5.9)years.The ROM,VAS,HSS,and SF-36 scores of group B and C at 3 months after surgery were significantly different from those of group A(P<0.01),and there was no statistical difference in the tibial plateau varus angle and the ratio of internal and external space(P>0.05 ).The ROM,VAS,HSS,and SF-36 scores of group A and group B were improved 1 year after operation as compared with those before operation,and there were statistical differences as compared with group C(P<0.05).No statistical difference was found in the tibial plateau varus angle internal and external space ratio(P>0.05).The ROM,VAS,HSS,and SF-36 scores of group A and group B improved 2 years after surgery,and there were significant statistical differences from group C(P<0.01).There was no difference between group A and B(P>0.05).The tibial plateau inversion angle and internal and external space were statistically different between group C and others(P<0.05).27 cases of local swelling happened in all,and 4 cases in group A,3 cases in group B experienced numbness and sensation in the back of the feet.They were recovered after treatment.Conclusion:Joint debridement only and joint debridement with proximal knee osteotomy are effective in the early treatment of medial-type KOA.Proximal fibula osteotomy,proximal fibula osteotomy combined with arthroscopic debridement are more effective in the early stage than arthroscopy.Satisfactory curative effects have been achieved in the middle and mid-term.Fibula osteotomy can also partially adjust the knee joint line of force,which can reduce the pain of the medial knee joint,improve knee function,and obtain better mid-term clinical effects,improve the quality of life of patients.Clinically,it should be flexibly applied in different stages of the patient’s condition.

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备注/Memo

备注/Memo:
(收稿日期:2019-08-07)基金项目:广西壮族自治区卫生和计划生育委员会自筹课题项目(Z20170799)△通信作者 E-mail:Petergouly@163.com
更新日期/Last Update: 2020-06-10