腓骨近端截骨术与口服药物治疗膝关节骨关节炎的对比研究

Therapeutic effect analysis of proximal fibular osteotomy for the treatment of patients with knee osteoarthritis

目的探讨腓骨近端截骨术治疗膝关节骨关节炎患者的临床疗效。方法回顾性收集2012年11月至2015年11月井陉县医院收治的符合纳入及排除标准的膝关节骨关节炎患者341例，根据治疗方法不同分为腓骨截骨组（n=171）和口服药物组（n=170）。腓骨截骨组患者采用患侧腓骨近端截骨术，口服药物组则给予口服非甾体抗炎药、氨基葡萄糖。分别于术后1周、1个月、3个月、12个月，随访并比较两组患者美国特种外科医院（hospital for special surgery，HSS）膝关节评分、疼痛视觉模拟评分（visual analogue scale，VAS）、曼彻斯特大学关节炎指数（westemontario and McMaster Universities osteoarthritis index，WOMAC）、内侧间室高度及胫股角的变化。结果341例患者均获得满意随访，随访时间12～16个月，平均13个月。术前两组患者的HSS、VAS评分及胫股角差异无统计学意义（P〉0．05），且腓骨截骨组WOMAC评分高于口服药物组，内侧间室高度低于口服药物组（P〈0．05）。术后1个月、3个月、12个月时腓骨截骨组VAS及WOMAC评分均低于口服药物组患者（P〈0．05），HSS评分及内侧间室高度均高于口服药物组患者（P〈0．05）；与术前相比，腓骨截骨组患者的HSS、VAS、WOMAC评分及内侧间室高度、胫股角均明显改善，差异有统计学意义（P〈0．05），口服药物组患者的各指标改善不明显，差异无统计学意义（P〉0．05）。但腓骨截骨组中有5例（2．9％）患者于术后第1天出现腓总神经损伤，以足背感觉障碍，拇背伸不能为主，其中1例（0．05％）行肌腱移位，余均自行恢复。结论腓骨近端截骨术治疗膝关节骨关节炎效果优于口服药物，可有效改善膝关节功能、缓解膝关节内侧疼痛，费用较低、出血量较少，是值得推广的手术方式。

Objective To investigate the clinical efficacy of proximal fibular osteotomy for the treatment of patients with knee osteoarthritis. Methods 341 patients with knee osteoarthritis who were treated in Jingxing County Hospital from November 2015 to November 2012 were collected retrospectively. According to different treatment methods, the patients were divided into the fibular osteotomy group （n=171） and the oral medication group （n=170）. The fibular osteotomy group were treated with the ipsilateral proximal fibular osteotomy, oral medicine group were given oral non steroidal anti- inflammatory drugs, glucosamine. The hospital for special surgery （HSS） knee score, the visual analogue scale （VAS）, the western ontario and McMaster Universities osteoarthritis index （WOMAC）, and the changes of the medial compartment height and the femorotibial angle of the patients in these two groups were followed-up and made comparison 1 week, 1 month, 3 months, and 12 months after the operation respectively. Results 341 patients were followed up for 12 to 16 months, with an average of 13 months. The HSS, VAS and the femorotibial angle of patients preoperatively showed no statistically significant difference between two groups （P〉0.05）, the WOMAC score of proximal fibula osteotomy group was higher than that of the oral drug group, the medial tibiofemoral compartment height of proximal fibula osteotomy group was lower than that of the oral drug group （P〈0.05）. The WOMAC and VAS score of patients treated 1 month, 3 months, 12 months after proximal fibula osteotomy was lower than that of the oral drug group （P〈0.05）. The HSS score and the medial compartment height of patients treated 1 month, 3 months, 12 months after proximal fibula osteotomy were both higher than that of the oral drug group; The WOMAC score of patients treated 1 month, 3 months, 12 months after proximal fibula osteotomy was lower than that of the oral drug group （P〈0.05）. Compared with the preoperative values, the HSS, VAS, WOMAC score, medial tibiofemoral compartment height, and femorotibial angle in proximal fibular osteotomy group were all significantly improved, and the difference was statistically significant （P〈0.05）. On the contrary, there were no statistically significant differences in terms of these values in the oral drug group （P〉0.05）, indicating no significant improvement of symptom recovery. However, 5 cases in the surgery group （2.9%） showed peroneal nerve injury, dorsal sensory disturbances, and hallux dorsiflexion disablement on the first day after surgery, in which one case （0.05%） underwent transposition of tendon, and the rest were spontaneously recovered. Conclusions The therapeutic effect of proximal fibular osteotomy for the treatment of knee osteoarthritis is better than that of oral drug treatment, which can effectively alleviate the medial knee pain withlow cost, less bleeding, and effectively improve the function of knee joint, recover the medial compartment height and femorotibial angle. Thus, it is an alternative operation for the treatment of knee osteoarthritis, which is easily accepted by doctors and patients and worth popularizing.