腓骨高位截骨术在膝关节内侧间室骨关节炎中的应用

Application of high fibula osteotomy in the treatment of osteoarthritis medial compartment

目的探讨膝关节内侧间室骨关节炎患者行腓骨高位截骨术治疗的疗效及安全性。方法膝关节内侧间室骨关节炎患者30例,均行腓骨高位截骨术,记录术后3个月并发症发生情况;分别于术前及术后2d、3个月行X线片测量膝关节内外间室高度比,应用视觉模拟评分(visual analogue scale,VAS)评估膝关节疼痛程度,应用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分评估膝关节功能。结果 30例手术均成功,术后疼痛明显减轻;术后2d、3个月VAS评分[(3.02±1.87)、(2.04±0.91)分]均低于术前[(6.42±1.54)分],HSS膝关节评分[(71.35±4.27)、(79.16±5.25)分]均高于术前[(53.63±6.45)分],且术后3个月较术后2d变化明显(P<0.05);术后3个月膝关节内外间室高度比(0.42±0.28)高于术前(0.30±0.15)(P<0.05),术后2d(0.32±0.25)与术前比较差异无统计学意义(P>0.05);1例术后3个月出现肌间静脉血栓形成,对症治疗后恢复正常,余无感染及神经损伤发生。结论腓骨高位截骨术治疗膝关节内侧间室骨关节炎效果满意,可有效减轻患者疼痛、改善膝关节功能,且并发症少。

Objective To explore the effect and safety of high fibula osteotomy in the treatment of knee osteoarthritis of medial compartment. Methods Thirty patients with medial compartment osteoarthritis were treated by high fibula osteotomy. The occurrence of complications in 3 months after operation was recorded. The internal and external knee joint height ratio was measured by Xray examination before, and by day 2 and in 3 months after operation. The pain and function of the knee joint were assessed by visual analogue scale （VAS） and Hospital for Special Surgery （HSS） knee score. Results The operation was successfully performed in all patients and the pain was relieved. The VAS scores （3.02±1.87, 2.04±0. 91） by day 2 and in 3 months after operation were significantly lower and HSS knee scores （71.35±4.27, 79.16±5.25） were significantly higher than those before operation （6.42±1.54, 53.63±6.45）, which was more obvious in 3 months after operation in comparison with those by day 2 after operation （P〈0.05）. The height ratio of the internal and external knee joint in 3 months after operation （0.42±0.28） was significantly larger than that before operation （0.30±0.15） （P〉0.05） , and showed no significant difference by day 2 after surgery （0.32-0.25） in comparison with before operation （P〉0.05）. Myasthenia vein thrombosis occurred in one patient in 3 months after operation and returned to normal after anticoagulant symptomatic treatment. No infection or nerve damage was found. Conclusion High fibula osteotomy can effectively reduce pain and improve knee function in the treatment of knee osteoarthritis of medial compartment, the result is satisfactory and the complication is fewer.