关节镜联合开放楔形胫骨高位截骨术治疗膝关节内侧间室骨性关节炎的疗效

Efficacy of arthroscopy combined with open wedge high tibial osteotomy in the treatment of medial compartmental knee osteoarthritis

目的探讨关节镜联合开放楔形胫骨高位截骨术(OWHTO)治疗膝关节内侧间室骨性关节炎的临床疗效。方法选取2018年2月至2020年2月本院收治的膝关节内侧间室骨性关节炎患者94例, 按随机数字表法分为观察组和对照组, 每组47例。观察组采取关节镜探查清理联合OWHTO, 对照组采取关节镜探查清理联合腓骨近端截骨术。比较两组手术时间、出血量、术后下地时间、住院时间, 记录术前及术后12个月两组患者股胫角、胫骨近端内侧角、下肢力线比率、胫骨平台后倾角、美国特种外科医院评分(HSS)、Lysholm评分及并发症发生情况。结果两组手术时间、住院时间比较, 差异均无统计学意义(均P>0.05)。与对照组比较, 观察组出血量与术后下地时间均显著增加(均P<0.05)。术后12个月, 两组股胫角均较术前降低、胫骨近端内侧角均较术前升高(均P<0.05)。术后12个月观察组股胫角高于对照组、胫骨近端内侧角低于对照组(均P<0.05)。术后12个月两组下肢力线比率及对照组胫骨平台后倾角较术前增大(均P<0.05), 观察组胫骨平台后倾角较术前无明显变化(P>0.05)。术后12个月观察组下肢力线比率高于对照组, 胫骨平台后倾角低于对照组(均P<0.05)。术后12个月两组HSS评分、Lysholm评分均较术前升高(均P<0.05)。术后12个月观察组HSS评分、Lysholm评分均高于对照组(均P<0.05)。随访12个月, 两组均未出现显著并发症。结论关节镜联合OWHTO治疗膝关节内侧间室骨性关节炎的手术创伤虽然相对更大, 但其力线矫正效果满意, 膝关节功能改善幅度更大, 并发症少, 具有较高的可行性。

Objective To investigate the clinical efficacy of arthroscopy combined with open wedge high tibial osteotomy(OWHTO)in the treatment of medial compartmental knee osteoarthritis(KOA).Methods A total of 94 patients with medial compartmental KOA treated in our hospital between February 2018 and February 2020 were included and divided into the study group and the control group according to random number table(n=47 each).The study group received arthroscopic exploration and clearance combined with OWHTO,while the control group received arthroscopic exploration and clearance combined with proximal fibular osteotomy.The operative time,blood loss,time to ambulation after surgery,length of hospital stay,as well as the tibial femoral angle,proximal medial angle of tibia,lower limb force line ratio,posterior angle of tibial plateau,Hospital for Special Surgery(HSS)score and Lysholm score before and at 12 months after surgery,and the incidence of complications,were compared between the two groups.Results There were no statistically significant differences in operative time and length of hospital stay between the two groups(both P>0.05).Compared with the control group,the study group experienced significantly more blood loss and longer time to ambulation after surgery(both P<0.05).At 12 months after surgery,the both groups showed smaller tibial femoral angle and greater proximal medial tibial angle compared with baseline(all P<0.05);moreover,the study group showed greater femoral tibial angle and smaller proximal medial tibial angle than those in the control group(both P<0.05).At 12 months after surgery,the lower limb force line ratios in the both groups and the posterior inclination of the tibial plateau in the control group were increased as compared with baseline(all P<0.05),while the posterior inclination of the tibial plateau in the study group did not show significant change(P>0.05).At 12 months after surgery,the lower limb force line ratio was higher,and the posterior inclination of the tibial plateau was lower,in the study group than those in the control group(both P<0.05).At 12 months after surgery,the HSS score and Lysholm score in both groups were higher than baseline(all P<0.05),and these scores were higher in the study group than those in the control group(both P<0.05).During the follow-up for 12 months,no major complications occurred in either group.Conclusion Arthroscopy combined with OWHTO in the treatment of medial compartmental KOA,despite with relatively greater surgical trauma,may result in satisfactory correction of force line,greater improvement of knee function,fewer complications,and therefore appears highly feasible.