开放楔形胫骨高位截骨术联合关节镜手术治疗内侧间室型膝关节骨性关节炎疗效分析

Open wedge high tibial osteotomy combined with arthroscopy for knee osteoarthritis of medial compartment

目的评估开放楔形胫骨高位截骨术联合关节镜手术治疗内侧间室型膝关节骨性关节炎的早期临床疗效。方法回顾性分析自2019-05—2020-12采用开放楔形胫骨高位截骨术联合关节镜手术治疗的32例(36膝)内侧间室型膝关节骨性关节炎。比较术前、术后12个月下肢力线比值、股胫角、胫骨近端内侧角。于术前、术后1个月、术后6个月、术后12个月采用HSS评分评定膝关节功能,采用疼痛VAS评分评价疼痛缓解程度。结果32例均获得至少12个月随访,随访期间未出现感染、内固定物断裂、截骨端不愈合等并发症。2例术中出现合页部骨折,采用Tomfix胫骨近端内侧解剖锁定钢板坚强固定,术后随访未见截骨间隙不愈合及胫骨平台后倾角丢失情况发生。术后12个月下肢力线比值、股胫角、胫骨近端内侧角较术前明显改善,差异有统计学意义(P<0.05)。术后1、6、12个月膝关节功能HSS评分较术前明显增加,疼痛VAS评分较术前明显降低,差异有统计学意义(P<0.05)。结论开放楔形胫骨高位截骨术与关节镜手术联合应用可调整下肢力线、改变膝关节应力分布、有效缓解膝关节疼痛、改善膝关节功能,是内侧间室型膝关节骨性关节炎的一种有效治疗方案。

Objective To evaluate the early clinical outcomes of open wedge high tibial osteotomy combined with arthroscopic surgery for medial compartmentalized knee osteoarthritis.Methods Thirty-two cases(36 knees)of medial compartment type knee osteoarthritis treated with open wedge high tibial osteotomy combined with arthroscopic surgery from May 2019 to Decem⁃ber 2020 were retrospectively analyzed.The lower extremity force line ratios,femoral-tibial angle,and proximal medial tibial angle before and 12 months after operation were compared.The HSS score was used to assess knee function before,1,6 and 12 months after surgery,and the VAS score was used to evaluate the degree of pain relief.Results All 32 cases were followed up for at least 12 months,and no complications such as infection,break of the internal fixation,or non-union of the osteotomy end occurred during the follow-up period.Two cases had intraoperative hinge fractures,which were fixed with Tomfix proximal tibi⁃al medial anatomic locking plates,and no nonunion of the osteotomy gap or loss of posterior tibial plateau angle was observed at postoperative follow-up.At 12 months after surgery,the lower limb force ratio,femoral-tibial angle,and proximal medial tibial angle were significantly improved compared with those before surgery,and the difference was statistically significant(P<0.05).The HSS score of knee function at 1,6 and 12 months after surgery increased significantly and the VAS score decreased signifi⁃cantly compared with that before surgery,and the difference was statistically significant(P<0.05).Conclusion The combina⁃tion of open wedge high tibial osteotomy and arthroscopic surgery can adjust the lower limb force line,change the knee stress distribution,effectively relieve knee pain,and improve knee function,which is an effective treatment option for medial compart⁃ment type knee osteoarthritis.