腓骨近端截骨联合经皮骨骼肌松解治疗膝内侧间室骨性关节炎

Knee Osteoarthritis Treatment by Fibular Osteotomy Combined With Percutaneous Skeletal Muscle Release

目的评估腓骨近端截骨联合经皮骨骼肌松解治疗膝关节内侧间室骨性关节炎（OA）的疗效。方法将符合纳入标准的60例OA患者随机分成两组,观察组患者先在局麻下行腓骨后外侧入路,腓骨头下约6-10 cm处截除约1.5-2 cm腓骨,截骨后缝合术口并包扎。然后再行膝关节骨骼肌止点的阳性压痛点处局麻后银质针经皮骨骼肌松解术,具体操作方法如下：选取术前在膝前部膑骨下缘及内外膝眼处预先检查并标记的压痛点布针,针距1.5 cm,各标记点行0.5%利多卡因皮内注射,形成直径约2 mm的皮丘,采用宣蛰人发明的银质针沿上述标记部位布针,银质针直刺达骨膜下,连接巡检仪加热银质针,设定温度90℃,加热15 min后关机,再次碘伏消毒术区,敷料包扎。对照组则忽略腓骨近端截骨,只局麻下行膝关节压痛点经皮骨骼肌松解术;比较两组患者手术前、手术后1周和3个月时视觉模拟评分（VAS评分）和西安大略和麦克马斯特大学骨关节指数评分（WOMAC评分）。结果和手术前相比,两组手术后1周及3个月时VAS评分和WOMAC评分均有明显改善,差异有统计学意义（P〈0.05）,观察组在WOMAC具体评分优于对照组（P〈0.05）。结论腓骨近端截骨联合经皮骨骼肌松解术能有效缓解膝关节内侧间室骨性关节炎（OA）患者关节疼痛,肿胀,减轻关节僵硬,有效改善关节活动度。

Objective Evaluate the effect of osteoosteo arthritis（OA） treatment by fibular osteotomy combined with percutaneous skeletal muscle release. Methods 60 OA patients were divide into two groups, and the patients in observation group first accepted the fibular lateral approach under local anesthesia, amputated 1.5-2 cm fibula 6-10 cm below the fibular head, and then sutured and bound it up. Then they accepted the sliver needle percutaneous skeletal muscle release of knee skeletal muscle stop under the local anesthesia in positive pressure point. Specific method： arranged the needle in the pre-checked pressure points in the patella, inside and outside knee eyes before the surgery with the needle pitch of 1.5 cm, and each point accepted 0.5% lidocaine injection, the piciu with the diameters of 2 mm was formed, the needle directly inserted into the periosteum, and heated the silver needles connected to itinerant detector with the set temperature of 90℃. Powered off after heating for 15 min, and disinfected the operating zone with iodine, and dressed and bound it up. The patients in control group ignored the fibular osteotomy, but accepted the percutaneous skeletal muscle release in knee pressure point under the local anesthesia, compared the VAS and WOMAC of the two groups before the surgery, 1 week and 3 months after the surgery. Results Compared to that before the surgery, the VAS and WOMAC of the two groups 1 week and 3 months after the surgery was improved significantly with the statistical significance（P〈0.05）, and the WOMAC of observation group was better than that of the control group（P〈0.05）. Conclusion The fibular osteotomy combined with percutaneous skeletal muscle release could effectivelyrelieve the arthralgia and tumidness of OA patients, alleviate the ankylosis, and effectively improve the motion of joint.