腓骨近端截骨术与人工全膝关节置换术治疗内翻型膝关节骨关节炎的短期疗效比较

Comparison of the short-term efficacy of peroneal proximal osteotomy and total knee arthroplasty for treatment of varus knee osteoarthritis

目的观察腓骨近端截骨术与人工全膝关节置换术(TKR)治疗内翻型膝关节骨关节炎的短期疗效。方法回顾性分析2015年4月至2017年9月雅安市中医医院收治的105例内翻型膝关节骨关节炎患者的病例资料,按照治疗方法的不同,将其分为试验组(n=52)与对照组(n=53)。试验组患者行腓骨近端截骨术治疗,对照组患者行TKR术治疗。观察两组患者的围手术期临床指标、术前术后7 d、90 d美国特种外科医院(HSS)评分及疼痛视觉模拟评分(VAS)变化情况、血红蛋白水平及并发症发生率。结果试验组患者的术中出血量(34.2±15.5 ml vs.509.4±139.3 ml)、术中输血量(0 ml vs.129.4±57.3 ml)、手术时间(16.5±6.4 min vs.72.6±15.9 min)、住院天数(3.4±2.9 d vs.12.9±4.6 d)及治疗总费用(3 504.5±531.6元vs.47 634.8±8 329.6元)等临床指标均优于对照组,组间比较差异具有统计学意义(P<0.05)。两组患者术前HSS评分(40.56±14.91分vs.40.29±15.41分)、VAS评分(6.71±2.59分vs.6.75±2.44分)及血红蛋白水平(12.18±1.49 g/L vs.12.16±1.38 g/L)比较差异无统计学意义(P>0.05),两组患者术后90 d的HSS评分(70.81±19.69分vs.71.51±19.31分)、VAS评分(2.17±0.96分vs.2.23±0.91分)均优于术前(P<0.05),但变化幅度接近,组间比较差异无统计学意义(P>0.05);试验组患者术后7 d血红蛋白水平无变化,对照组患者术后7 d血红蛋白水平降低,组间比较差异具有统计学意义(P<0.05)。试验组患者3例出现术后初期腓浅神经损伤,术后90 d后自愈;对照组患者术后3例出现下肢深静脉血栓(DVT),经对症抗凝治疗后好转;两组患者的术后并发症发生情况无显著差异(P>0.05)。结论腓骨近端截骨术与TKR术对于内翻型膝关节骨关节炎的短期治疗效果无显著差异,与TKR术比较,腓骨近端截骨术具有术中损伤小、出血量低及治疗费用低的优势,临床应用前景广阔。

Objective To explore the short-term efficacy of peroneal proximal osteotomy and total knee replacement(TKR)in treatment of varus knee osteoarthritis.Methods The clinical data of 105 patients with varus knee osteoarthritis admitted to this hospital during April 2015 to September 2017 were retrospectively analyzed.According to different treatment methods,all patients were divided into trial group(n=52)and control group(n=53).Patients in trial group underwent proximal humerus osteotomy,and patients in control group underwent TKR.The perioperative clinical indexes,the changes of US Special Surgery Hospital(HSS)scores and pain visual analogue scale(VAS)scores,hemoglobin levels and complication rates were observed in these two groups.Results The amount of intraoperative blood loss(34.2±15.5 ml vs.509.4±139.3 ml),intraoperative blood transfusion(0 vs 129.4±57.3 ml),operating time(16.5±6.4 min vs.72.6±15.9 min),hospital stay(3.4±2.9 d vs.12.9±4.6 d)and total therapeutic cost(3 504.5±531.6 yuans vs.47 634.8±8 329.6 yuans)were superior to those of control group,and the difference between these 2 groups was statistically significant(P<0.05).There was no difference in preoperative HSS scores(40.56±14.91 points vs.40.29±15.41 points),VAS scores(6.71±2.59 points vs.6.75±2.44 points),and hemoglobin levels(12.18±1.49 g/L vs.12.16±1.38 g/L).The difference was significant(P>0.05),HSS scores(70.81±19.69 points vs.71.51±19.31 points)and VAS scores(2.17±0.96 points vs.2.23±0.91 points)were better than those before surgery(P<0.05).However,the magnitude of these changes was similar,and the difference between these two groups was not statistically significant(P>0.05).There was no change in hemoglobin level in trial group in 7 days after operation,and the hemoglobin level in control group was decreased in 7 days after the operation.The difference between these 2 groups was statistically significant(P<0.05).In trial group,3 patients had early superficial peroneal nerve injury and self-healing after 90 days.Three patients in control group had postoperative deep venous thrombosis(DVT),and it had been improved after symptomatic anticoagulant therapy.The incidence of postoperative complications was close(P>0.05).Conclusion The effect of short-term treatment of pfo and TKR for osteoarthritis of the knee with varus was not significantly different.In comparison with TKR,peroneal proximal osteotomy has the advantages of little damage,low blood loss and less treatment cost,hence its clinical application prospect is wide.