单髁置换术与腓骨上段截骨联合关节镜清理术治疗膝关节内侧间室骨性关节炎的对比研究

Comparative study on unicompartmental knee arthroplasty and proximal fibular osteotomy combined with arthroscopic debridement in treatment of knee osteoarthritis

目的 比较单髁置换术与腓骨上段截骨联合关节镜清理术治疗膝关节内侧间室骨性关节炎的临床疗效,为临床上选择个体化治疗方案提供依据.方法 选取中老年膝关节内侧间室骨性关节炎患者63例,其中采用单髁置换术治疗26例(单髁置换组),采用腓骨上段截骨联合关节镜清理术治疗37例(截骨清理组).比较两组患者手术时间、住院时间、住院费用、手术前后美国纽约特种外科医院(HSS)膝关节评分、疼痛视觉模拟量表(VAS)评分和术后并发症发生情况.结果 截骨清理组患者手术时间、住院时间和住院费用均低于单髁置换组,差异均有统计学意义(均P<0.05).与术前比较,两组患者术后1周、6个月和12个月HSS评分均增加,VAS评分均下降,差异均有统计学意义(均P<0.05).单髁置换组患者术后无一例出现感染及脱位等并发症.截骨清理组患者术后1例出现小腿及足外侧麻木,给予对症处理后明显好转.结论 两种方法均可明显改善膝关节功能,缓解疼痛,提高患者生活质量.临床上应根据患者各方面综合情况(特别是经济情况)、医院条件、术者的手术经验等,个体化选择治疗方案.

Objective To compare the clinical efficacy of unicompartmental knee arthroplasty(UKA)and proximal fibular osteotomy(PFO)combined with arthroscopic debridement in the treatment of knee osteoarthritis(KOA).Methods 63 patients with KOA were enrolled in the study,including 26 cases treated with UKA(UKA group)and 37 cases treated by PFO combined with arthroscopic debridement(combination group).The pain score,the function of knee joint,operation time,length of hospital stay,medical cost were compared between the two groups.Results The operation time,length of hospital stay were shorter,medical cost was lower in the combination group than those in UKA group(all P<0.05).Compared with preoperative results,the HSS sore increased and VAS score reduced at 1 week,6 month,12 month postoperatively in both groups(all P<0.05).There was no postoperative complication such as infection and dislocation in UKA.Postoperative numbness on the lateral shank and foot was found in 1 patient of combination group,and it was improved after symptomatic treatment.Conclusion Both methods can improve the function of knee joint and relieve the pain for patients with knee osteoarthritis.The surgical modalities can be chosen individually according to patient's financial condition,surgeon's experience and medical conditions.