[1]郭浩山,谢晓音,潘超△,等.三种截骨保膝方案治疗膝内侧间室骨关节炎的疗效比较[J].中国中医骨伤科杂志,2024,32(04):39-43.[doi:10.20085/j.cnki.issn1005-0205.240408]
　GUO Haoshan,XIE Xiaoyin,PAN Chao,et al.Comparison of the Curative Efficacy of Three Kinds of Osteotomy to Protect the Knee on the Treatment of Medial Knee Osteoarthritis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(04):39-43.[doi:10.20085/j.cnki.issn1005-0205.240408]
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三种截骨保膝方案治疗膝内侧间室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32卷
期数:
2024年04期
页码:
39-43
栏目:
临床研究
出版日期:
2024-04-01

文章信息/Info

Title:
Comparison of the Curative Efficacy of Three Kinds of Osteotomy to Protect the Knee on the Treatment of Medial Knee Osteoarthritis
文章编号:
1005-0205(2024)04-0039-05
作者:
郭浩山1; 谢晓音2; 潘超3△; 马建1; 李楠1; 刘晓之1
1聊城市中医医院(山东 聊城,252000)
2聊城市退役军人医院
3莒南县人民医院
Author(s):
GUO Haoshan1; XIE Xiaoyin2; PAN Chao3△; MA Jian1; LI Nan1; LIU Xiaozhi1
1Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng 252000,Shandong China; 2Liaocheng Veterans Hospital,Liaocheng 252000,Shandong China; 3People's Hospital of Junan,Junan 276600,Shandong China.
关键词:
膝骨关节炎;  胫骨高位截骨术;  腓骨近端截骨术;  关节镜;  保膝
Keywords:
knee osteoarthritis;  high tibial osteotomy;  proximal fibular osteotomy;  arthroscopy;  knee protection
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.240408
文献标志码:
A
摘要:
目的:对比单纯开放楔形胫骨高位截骨术、关节镜清理联合开放楔形胫骨高位截骨术、关节镜清理联合腓骨近端截骨术三种保膝方案治疗膝内侧间室骨关节炎的疗效。方法:自2016年1月至2022年8月,82例(82膝)内侧膝骨关节炎患者接受保膝手术治疗,根据治疗方案的不同分为3组:A组单纯行开放楔形胫骨高位截骨术(23例),B组行关节镜清理联合开放楔形胫骨高位截骨术(30例),C组行关节镜清理联合腓骨近端截骨术(29例)。分别记录三组手术时间、围手术期出血量、术前及术后随访时美国特种外科医院(HSS)评分、视觉模拟量表(VAS)评分,进行疗效评价。结果:所有病例均获得随访,随访时间平均为(20.4±8.5)个月。A组和C组手术时间差异无统计学意义(P>0.05),均较B组短,差异有统计学意义(P<0.05); A组和B组围手术期出血量差异无统计学意义(P>0.05),均较C组多,差异有统计学意义(P<0.05)。术后12个月三组HSS评分和VAS评分较术前均有改善,差异有统计学意义(P<0.05); A组和B组差异无统计学意义(P>0.05),均较C组改善更为明显,差异有统计学意义(P<0.05)。结论:三种保膝方案治疗膝内侧间室骨关节炎均起到良好效果,联合关节镜能够处理半月板损伤、软骨损伤等病变,但并没有显著提高胫骨高位截骨术的疗效,单纯进行胫骨高位截骨术即可取得令人满意的疗效,腓骨近端截骨术远期疗效逊于胫骨高位截骨术,但创伤小、花费少、术后可早期完全负重行走是其优点。
Abstract:
Objective:To compare the efficacy of three knee-preserving schemes:open wedge high tibial osteotomy,arthroscopic debridement combined with open wedge high tibial osteotomy,and arthroscopic debridement combined with proximal fibular osteotomy on medial knee osteoarthritis.Methods:82 patients(82 knees)with medial knee osteoarthritis received knee-preserving surgery from January 2016 to August 2022,which were divided into three groups according to the different treatment options:group A was open wedge high tibial osteotomy(23 cases),group B underwent arthroscopic debridement combined with open wedge high tibial osteotomy(30 cases),group C underwent arthroscopic debridement combined with proximal fibular osteotomy(29 cases).The operation time,perioperative blood loss,Hospital of Special Surgery(HSS)scores and visual analogue scale(VAS)scores during preoperative and postoperative follow-up in the three groups were recorded,and the efficacy was evaluated.Results:All cases were followed up with an average time of(20.4±8.5)months.There was no statistically significant difference in operation time between groups A and C(P>0.05),and both were shorter than group B,and the difference was statistically significant(P<0.05).There was no significant difference in perioperative blood loss between groups A and B(P>0.05),which were more than those in group C,and the difference was statistically significant(P<0.05).The HSS scores and VAS scores of the three groups were improved at 12 months after surgery compared with those before the operation,and the difference was statistically significant(P<0.05),comparison among the three groups showed that:the difference between group A and group B was not statistically significant(P>0.05),and both improved more significantly than group C,and the difference was statistically significant(P<0.05).Conclusion:The three knee-preserving schemes have good efficacy on medial knee osteoarthritis.Combined arthroscopy can treat meniscus injuries and cartilage injuries,but it does not significantly improve the efficacy of high tibial osteotomy.Opening wedge high tibial osteotomy(OWHTO)can achieve satisfactory results.Proximal fibula osteotomy is inferior to high tibial osteotomy in long-term efficacy,but its advantages are less trauma,less cost,and full weight bearing early after surgery.

参考文献/References:

[1] 中华医学会骨科学分会.骨关节炎诊断及治疗指南(2007版)[J].中国矫形外科杂志,2014,22(3):287-288.
[2] KELLGREN J H,LAWRENCE J S.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[3] INSALL J N,RANAWAT C S,AGLIETTI P,et al.A comparison of models of total knee-replacement prostheses[J].J Bone Joint Surg Am,1976,58(6):754-765.
[4] JACKSON J P,WAUGH W.Tibial osteotomy for osteoarthritis of the knee[J].Proc R Soc Med,1960,53(10):618.
[5] COVENTRY M B.Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee:a preliminary report[J].J Bone Joint Surg Am,1965,47:984-990.
[6] HERNIGOU P,MEDEVEIELLE D,DEBEYRE J,et al. Proximal tibial osteotomy for osteoarthritis with varus deformity:a ten to thirteen-year follow-up study[J].J Bone Joint Surg Am,1987,69(3):332-354.
[7] LEE S C,JUNG K A,NAM C H,et al.The short-term follow-up results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft:the minimum 1-year follow-up results[J].Clin Orthop Surg,2010,2(1):47-54.
[8] 黄野.胫骨高位截骨术治疗膝关节骨关节炎的现状[J].中华关节外科杂志(电子版),2016,10(5):470-473.
[9] 郭浩山,谢晓音,刘晓之,等.模拟负重CT定位像下肢全长片在膝骨关节炎胫骨高位截骨术中的应用[J].中国中医骨伤科杂志,2023,31(8):54-58.
[10] 张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究[J].河北医科大学学报,2014,35(2):218-219.
[11] 陈蕾,李江伟,郑明.腓骨高位截骨对膝关节应力改变的三维有限元分析[J].中国骨与关节损伤杂志,2018,33(6):583-585.
[12] 莫诒向,邓羽平,黄文华,等.腓骨高位截骨术对胫骨平台的生物力学分析[J].中国医学物理学杂志,2020,37(5):644-648.
[13] 李存祥,李德思.膝关节腓骨截骨术的生物力学研究[J].实用骨科杂志,2020,26(12):1139-1142.
[14] 齐万里,于东旭,高宏伟.等.针刀镜联合腓骨近端截骨术治疗膝骨关节炎20例[J].中国中医骨伤科杂志,2021,29(11):58-60.
[15] 刘道兵,王荣田,李䶮.等.腓骨近端截骨术治疗膝骨关节炎的疗效[J].临床骨科杂志,2022,25(5):639-643.
[16] 郭浩山,田义军,安龙,等.关节镜联合腓骨近端截骨术与胫骨高位截骨术治疗膝内侧间室骨性关节炎的疗效比较[J].中国骨与关节损伤杂志,2020,35(10):1076-1078.

备注/Memo

备注/Memo:
基金项目:聊城市重点研发计划政策引导类项目(2022YDSF66)
山东省中医药科技项目(2021Q011)
△通信作者 E-mail:ghs2614264@126.com
更新日期/Last Update: 2024-04-15