关节镜下清理联合腓骨上段截骨治疗膝关节骨性关节炎的临床研究

Clinical Study of Treatment of Knee Osteoarthritis by Arthroscopic Cleaning Combined with the Osteotomy of the Upper Section of the Fibula

目的：关节镜下清理联合腓骨上段截骨治疗膝关节骨性关节炎的临床疗效.方法：2014年1月-2016年6月采用关节镜下清理联合腓骨上段截骨治疗膝关节骨性关节炎患者45例,其中双膝9例,男性13例,女性32例,平均年龄59.3岁,收集手术前后患者患膝关节功能评分（HSS评分、VAS评分）,术后随访观察膝关节疼痛改善、功能恢复及并发症情况,评估治疗效果.结果：上述患者住院时间7-12天,中位数10天.术后所有患者均获随访,随访时间3-18个月.术后2例患者切口愈合不良,需2期清创及抗生素治疗,最终愈合良好,其余患者手术切口均甲级愈合,4例患者出现腓浅神经损伤表现,应用营养神经及针灸治疗后症状消失.根据特种外科医院膝关节评分量表（Hospital for Special Surgery Knee Score, HSS）评分评估临床效果：优20例,良14例,可9例,差2例,优良率为75.6%,根据膝关节疼痛视觉模拟量表（Visual Analogue Scale,VAS）评分,优25例,良8例,可10例,差2例,优良率为73.3%.结论：关节镜下清理联合腓骨上段截骨治疗膝关节骨性关节炎具有住院时间短、住院费用低、操作简单、并发症少、早期及远期治疗效果理想等特点,可以在临床推广.

Objective： To evaluate the clinical effect of the treatment of knee osteoarthritis （knee osteoarthritis,KOA） by arthroscopic cleaning combined with the osteotomy of the upper section of the fibula.Methods： From January 2014 to June 2016, 45 cases of knee osteoarthritis（knee osteoarthritis,KOA） were treated with arthroscopic cleaning combined with the osteotomy of the upper section of the fibula,among them 9 cases were knees, 13 males and 32 females, with an average age of 59.3 years, the scores of knee function （HSS score, VAS score） were collected before and after the operation, the patients were followed up to observe the knee joint pain improvement, functional recovery and complications after the operation, and evaluating the therapeutic effect.Results： The patients were hospitalized for 7-12 days with a median of 10 days.All patients were followed up, and the follow up time were 3-18 months.The incision condition of 2 cases were not so well after the operation, 2 stages of debridement and antibiotic treatment were needed, the final healing was well, the incisions of the remaining patients were surgical grade A healing, 4 patients with the damage of superficial fibular nerves, the symptoms disappeared after the treatment of nurturing the nerves and acupuncture.The clinical results were evaluated according to the Hospital for Special Surgery Knee Score（Hospital for Special Surgery Knee Score, HSS）： it was excellent in 20 cases, good in 14, fair in 9 and poor in 2, and the excellent and good rate was 75.6%.The score was evaluated according to the Visual Analogue Scale（Visual Analogue Scale,VAS）of the knee joint pain, it was excellent in 25 cases, good in 8, fair in 10 and poor in 2, the excellent and good rate was 73.3%.Conclusion： The treatment of knee osteoarthritis by arthroscopic cleaning combined with the osteotomy of the upper section of the fibula has the advantages of short hospitalization time, low hospitalization cost, simply operated, less complications and ideal early and long-term therapeutic effect, which is worth being popularized in clinical.