单纯腓骨高位截骨术与关节冲洗清理联合腓骨高位截骨术治疗膝骨关节炎的疗效比较

Comparative analysis of the effect of simple high cut of fibula and arthroscopic lavage debridement combined with fibular osteotomy in the treatment of knee osteoarthritis

目的：比较单纯腓骨高位截骨术与关节冲洗清理结合腓骨高位截骨术在治疗膝骨关节炎的短、长期疗效。方法回顾性分析45例膝骨关节炎患者的临床资料并根据手术方式进行分组，其中行单纯腓骨截骨术患者23例（对照组）；行关节清理冲洗结合腓骨高位截骨术患者22例（观察组）。比较两组患者术前及随访术后3、6、12个月的 VAS 评分和 AKS 膝关节评分。结果对照组与观察组术后3个月 VAS 评分和AKS 评分分别为（4．13±0．76）分、（3．45±0．60）分和（107．04±21．53）分、（126．64±14．24）分，观察组优于对照组（t ＝3．32、－3．62，均 P ＜0．05）；而两组术后6个月的 VAS 评分和 AKS 评分分别为（2．70±0．64）分、（2．70±0．73）分和（141．17±12．57）分、（146．45±7．26）分，两组比较差异无统计学意义（t ＝0．51、－1．72，均P ＞0．05）；术后12个月的 VAS 评分和 AKS 评分分别为（2．43±0．79）分、（2．41±0．85）分和（148．26±5．81）分、（148．59±5．53）分，两组比较差异无统计学意义（t ＝0．11、－0．20，均 P ＞0．05）。结论单纯腓骨截骨术对患者创伤小、花费少、手术难度小、并且长期临床疗效并不低于关节冲洗联合腓骨截骨术，故应在基层医院广泛开展。

Objective To compare the short and long term effect of knee osteoarthritis treatment with two therapeutic methods which are simple high cut of fibula and arthroscopic lavage debridement combined with fibular osteotomy.Methods Data of 45 consecutive patients with knee osteoarthritis were retrospectively observed and selected,and then they were divided into two groups according to the operation method.23 patients with simple high cut of fibula were selected as the control group,and 22 patients with arthroscopic lavage debridement combined with fibular osteotomy were selected as the observation group.Results The VAS and AKS scores of the control group at the time of 3m,6m,1 2m were （4.1 3 ±0.76）points,（1 07.04 ±21 .53）points;（2.70 ±0.64）points,（1 41 .1 7 ±1 2.57）points;（2.43 ±0.79）points,（1 48.26 ±5.81 ）points;and the scores of the observation group were （3.45 ± 0.60）points,（1 26.64 ±1 4.24）points,（2.70 ±0.73）points,（1 46.45 ±7.26）points,（2.41 ±0.85）points and （1 48.26 ±5.81 ）points.The differences between the two groups were statistically significant at the time of 3 months after surgery（t =3.32,-3.62,all P 〈0.05）,the effect of observation group was better than the control group;but the other indices had no statistically significant differences （t =0.51 ,-1 .72,0.1 1 ,-0.20,all P 〉0.05 ）. Conclusion The simple high cut of fibula with small trauma,less cost,less surgical difficulty,and long -term clini-cal curative effect is not less than the arthroscopic lavage and debridement combined with fibular osteotomy.There-fore,it should be carried out in the primary hospitals widely.