腓骨近端截骨术治疗内翻型膝关节骨关节炎的疗效研究

Clinical effect of proximal fibular osteotomy in the treatment of knee osteoarthritis

目的探讨腓骨近端截骨术治疗内翻型膝关节骨关节炎的临床效果。方法回顾性分析2014年10月至2015年8月邢台市骨科医院采用腓骨近端截骨术与人工全膝关节置换术(TKA)治疗的内翻型膝关节骨关节炎患者64例,根据术式不同分为腓骨截骨组(n=30)和TKA组(n=34)。腓骨截骨组患者男性6例(20%),女性24例(80%),平均年龄(53±5)岁。TKA组患者男性14例(41%),女性20例(59%),平均年龄(55±3)岁。随访比较两组患者术后3个月、6个月疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)膝关节评分、膝关节功能评分(KSS)。结果 64例患者中62例患者获得满意随访,随访时间为1~8个月,平均(4.2±1.1)个月。术前两组患者的HSS、KSS及VAS评分差异无统计学意义,术后6个月腓骨截骨组患者的HSS评分、KSS评分高于TKA组,VAS评分低于TKA组(t=-6.812,t=-3.241,t=-9.000,t=4.268,均P<0.05)。与术前相比,术后6个月时腓骨截骨组患者VAS评分由(6.8±1.0)分降到(0.8±0.4)分,降低了88%(F=32.232,P<0.01);HSS评分由(52±13)分升高到(82±8)分,升高了56%(F=-9.698,P<0.01);KSS临床评分由(54±9)分升高到(87±5)分,升高了59%(F=-14.187,P<0.01)。KSS功能评分由(50±9)分升高到(81±6)分,升高了64%(F=-12.151,P<0.01)。结论腓骨近端截骨术的近期疗效优于TKA,且具有创伤小、费用低、功能恢复效果好等优点,能够减轻患者痛苦,在一定程度上改善膝关节功能。

Objective To study the clinical effect of proximal fibular osteotomy in treating knee osteoarthritis. Methods From October 2014 to August 2015, the retrospective analysis was performed in 64 patients underwent proximal fibular osteotomy （PFO） and total knee arthroplasty （TKA）. All patients were divided into two groups： the proximal fibular osteotomy group （n=30） and TKA group （n=34）. Group PFO included 6 males and 24 females with an average age of 53±5 years. Group TKA included 14 males and 20 females with an average age of 55±3 years. The VAS （visual analogue scale）, HSS （hospital for special surgery） and KSS （keen society score） were compared between the two groups at the third and sixth month post-operatively. Results Sixty-two patients received an average of 4.2±1.1 months （range, 1-8 months） of follow- up. There was no statistically significant difference （P〉0.05） of HSS, KSS, and VAS between two groups before surgery, while the HSS and KSS score in PFO group was higher than that in TKA group, and theVAS score was lower than that inTKAgroup after surgery （t=-6.812, t=-3.241, t=-9.000, t=4.268, P〈0.05）. At the final follow-up, VAS score decreased to 0.8±0.4 from preoperative 6.8±1.0 with a percentage of 88% （F=32.232, P〈0.01）, the HSS score increased to 82±8 from preoperative 52±13 with a percentage of 56% （F=-9.698, P〈0.01）, the KSS clinical score increased to 87±5 from preoperative 54±9 with 59% （F=-14.187, P〈0.01）, the KSS functional score increased to 81±6 from preoperative 50±9 with 64% （F=-12.151, P〈0.01）. Conclusion The effect of PFO is better than TKA in osteoarthritis patients, with little trauma, low costs, knee function improvements et al., it can relieve patients’ pain and guarantee certain keen function.