腓骨近端截骨术联合关节镜清理治疗膝关节内侧间室骨关节炎的疗效

Effect of proximal fibular osteotomy combined with arthroscopic debridement for knee joint medial compartment osteoarthritis

目的比较腓骨近端截骨术联合关节镜清理与单髁关节置换术(UKA)治疗膝关节内侧间室骨关节炎的疗效。方法选取2014年1月至2015年1月在本院接受手术治疗的膝关节内侧间室骨关节炎患者36例(36膝),依患者自主意愿选择手术方式后分为2组:截骨术组(17例)行腓骨近端截骨术联合关节镜清理,UKA组(19例)行UKA。术后1、3、6、12个月返院随访,采用Lysholm评分、牛津膝关节评分(OKS)、膝关节损伤和骨关节炎结果评分(KOOS)评估关节活动度和关节功能,影像学随访评价假体情况、骨溶解及感染等并发症。结果两组患者年龄、性别、体质量指数、关节炎分级(均为Ⅲ~Ⅳ级)等无差别。UKA组手术时间和住院时间长于截骨术组,术中出血量及术后引流量多于截骨术组(P<0.05)。36例患者均得到随访,平均随访时间12.5个月。两组患者末次随访时Lysholm评分、OKS评分、KOOS评分均较术前明显改善(P<0.05)。两组患者Lysholm评分、OKS评分、KOOS评分与术前比较的改善程度无差异(P>0.05)。结论腓骨近端截骨术联合关节镜清理与UKA治疗膝关节内侧间室骨关节炎的近期疗效无差异,腓骨近端截骨术联合关节镜清理是一种值得推广的术式。

Objective To compare the clinical efficacy of proximal fibular osteotomy combined with arthroscopic debridement and unicompartmental knee arthroplasty(UKA)in treating knee joint medial compartment osteoarthritis.Methods A total of 36 patients(36 knee)with knee joint medial compartmental osteoarthritis from January 2014 to January 2015 were retrospectively analyzed.The patients were divided into two groups according to different operation modes which they chose independentiy:osteotomy group(17 cases)underwent proximal fibular osteotomy combined with arthroscopic debridement,while UKA group(19 cases)underwent UKA.All patients were followed up at1 st,3 rd,6 th and12 th month.The range of knee joint motion and knee function were evaluated by Lysholm score,Oxford Knee Score(OKS),Knee Injury and Osteoarthritis Outcome Score(KOOS).Prosthesis,osteolysis and complications such as infection were assessed by imageological examination.Results There were no difference in age,sex,body mass index(BMI),and arthritis calssification between two groups.The operation time and length of hospital stay of UKA group were longer than those of osteotomy group.The amount of intraoperative blood loss and postoperative drainage volume of UKA group were also larger than those of osteotomy group(P<0.05).All patients were followed up for an average time of 12.5 months.The Lysholm score,OKS score and KOOS score of both groups were significantly improved at the last follow-up(P<0.05).There were no difference between two groups in the Lysholm score,OKS score,KOOS score and degree of pain relief(P>0.05).Conclusion Both Proximal fibular osteotomy combined with arthroscopic debridement and UKA can effectively treat the knee joint medial compartment osteoarthritis,and there was no significant difference in short-term clinical outcomes between two groups.Proximal fibular osteotomy combined with arthroscopic debridement is a promising surgical procedure and is worth to be popularized.