腓骨近端截骨联合关节镜下清理治疗内翻型膝关节骨关节炎的成本效果分析

Cost-effectiveness analysis of proximal fibular osteotomy combined with arthroscopy debridement for medial compartment knee ostoarthritis

目的评价比较全膝关节置换术及膝关节镜清理+腓骨近端截骨术治疗内翻型膝关节骨关节炎的疗效和经济性。方法回顾性收集2014年11月到2015年1月河北医科大学第三医院收治的符合纳入及排除标准的内翻型骨关节炎患者20例,根据手术方式分为膝关节置换组(n=10)和截骨组(n=10),随访并比较两组患者的住院时间、美国特种外科医院(HSS)膝关节评分量表、疼痛视觉模拟评分(VAS)、内翻角、关节活动度及治疗成本。结果 20例患者获得完整随访,随访时间12个月。截骨组患者的住院时间(4.1±0.7)d明显少于膝关节置换组(15.8±3.6)d,差异有统计学意义(t=10.196,P<0.001);术前及术后膝关节置换组和截骨组的HSS评分、VAS评分、内翻角、关节活动度差异均无统计学意义(P>0.05)。末次随访时,A组患者的HSS评分由由术前(57±18)分提高至(81±12)分,升高了41.5%,截骨组由(58±17)分提高至(82±11)分,升高了40.3%;VAS评分膝关节置换组患者(7.7±0.7)分降至(1.3±1.2)分,截骨组由(7.5±0.8)分降至(1.4±1.1)分;膝关节置换组内翻角由(8.4±2.2)度改善至(2.1±1.4)度,截骨组由(8.3±2.5)度改善至(2.4±1.6)度;关节活动度膝关节置换组由(102±11)度改善至(127±6)度,截骨组由(102±10)度改善至(126±7)度,两组患者四项指标与术前相比差异均有统计学意义(膝关节置换组:t=-7.445,t=14.154,t=11.699,t=-10.113,P<0.001;截骨组:t=-9.413,t=19.398,t=10.069,t=-13.370,P<0.001);截骨组患者的治疗成本(7131.8±1004.8)元明显低于膝关节置换组(50915.6±1865.4)元,差异有统计学意义(t=18.442,P<0.001)。结论膝关节镜清理+腓骨近端截骨术及全膝关节置换术治疗内翻型膝关节骨关节炎均有良好临床效果,但前者操作简单、更加经济合理。

Objective To compare the efficacy and economic benifits of total knee arthroplasty(TKA) and knee arthroscopy debridement combined with proximal fibular osteotomy in the treatment of knee osteoarthritis. Methods A total of 20 eligible patients with medial compartment osteoarthritis were retrospectively selected in the Third Hospital of Hebei Medical University from November 2014 to January2015. Two groups were divided according to different surgical methods, 10 patients were treated with total knee replacement(group TKA) and the remaining 10 patients with knee arthroscopy debridement plus proximal fibula osteotomy(group PFO). Length of hospital stays, hospital for special surgery knee score(HSS), visual analogue scale(VAS), varus angle, range of motion(ROM) and treatment costs were compared between two groups. Results All patients were followed up at least 12 months. Hospital stays of patients in group PFO [(4.1 ± 0.7) d] were significantly shorter than that of group TKA [(15.8 ± 3.6) d] with statistical significance(t=10.196, P<0.001). There were no statistical significance of HSS, VAS, varus angleand ROM between two groups preoperation. In the last follow-up, the HSS scores increased by 41.5% in group TKA [from(57±18) to(81±12) points] and 40.3% in group PFO [from(58±17) to(82±11) points]compared to the preoperative, with statistical significance(t=-7.445, P<0.001; t=-9.413, P<0.001). VAS of group TKA and group PFO decreased from(7.7 ± 0.7),(7.5 ± 0.8) to(1.3 ± 1.2),(1.4 ± 1.1),respectively. Varus angle of two groups decreased from(8.4±2.2),(8.3±2.5) to(2.1±1.4),(2.4±1.6),respectively. ROM of two groups increased from(102 ± 11),(102 ± 10) to(127 ± 6),(126 ± 7),respectively. Preoperative VAS(t=14.154, P<0.001; t=19.398, P<0.001), varus angle(t=11.699, P<0.001;t=10.069, P<0.001) and ROM(t=- 10.113, P<0.001; t=- 13.370, P<0.001) were all significantly improved compared to the postoperative index. The treatment costs of group PFO(7131.8 ± 1004.8 yuan) was significantly lower than that of group TKA(50915.6±1865.4 yuan)(t=18.442, P<0.001). Conclusion Both the knee arthroscopy debridement plus proximal fibular osteotomy and total knee replacement surgery presented good clinical results in treating medial compartment knee osteoarthritis, but the knee arthroscopy debridement plus proximal fibular osteotomy was more easy-to-operate and sustain higher cost-effectiveness.