胫骨内侧开放截骨与外侧闭合截骨治疗膝关节内侧间室骨关节炎的疗效对比分析

Comparative Analysis of Curative Effect of Open Medial Tibial Osteotomy and Closed Lateral Osteotomy in the treatment of Medial Compartment Osteoarthritis of Knee Joint

目的:比较胫骨内侧开放截骨与外侧闭合截骨治疗膝关节内侧间室骨关节炎(OA)的效果。方法:收集2014年1月至2018年1月医院收治的87例膝关节内侧间室OA(均为单膝)患者的资料,按治疗方式分为开放组(胫骨内侧开放截骨术,n=47)与闭合组(胫骨外侧闭合截骨术,n=40),比较两组手术前后疼痛评分、膝关节功能评分及骨关节炎指数评分的变化,测定手术前后两组胫骨近端内侧角(MPTA)、股骨胫骨角(FTA)的变化,统计手术并发症发生率。结果:两组术后3个月视觉模拟评分(VAS)均降低(P<0.05),组间对比无差异(P>0.05);术后3、6、12个月两组膝关节功能评分(HSS)上升,骨关节炎指数评分(WOMAC)降低(P<0.05),组间对比无差异(P>0.05);术后12个月,两组FTA降低,MPTA上升(P<0.05),组间对比无差异(P>0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论:胫骨内侧开放截骨与外侧闭合截骨均可减轻膝关节内侧间室OA患者术后疼痛,纠正下肢力线,改善关节内翻畸形,且前者并发症相对较少。

Objective:To compare the effects of medial open tibial osteotomy and lateral closing tibial osteotomy on knee medial compartmental osteoarthritis(OA).Methods:The data of 87 patients with knee medial compartmental OA(both one knee)admitted to the hospital from January 2014 to January 2018 were collected.They were divided into open group(medial open tibial osteotomy,n=47)and closing group(lateral closing tibial osteotomy,n=40)according to the treatment methods.The pain score(VAS),knee function score and osteoarthritis index score before and after surgery were compared between the two groups.The changes of medial proximal tibial angle(MPTA)and femoral tibial angle(FTA)before and after surgery were measured in the two groups.The incidence of surgical complications was statistically analyzed.Results:The visual analogue scale(VAS)scores in the two groups decreased at 3 months after surgery,and the differences were statistically significant between groups(P<0.05).The Hospital for Special Surgery(HSS)scores in the two groups were increased at 3,6 and 12 months after surgery while the Western Ontario McMaster Universities(WOMAC)scores were decreased(P<0.05),and there were no statistically significant differences between groups(P>0.05).At 12 months after surgery,FTA was decreased while MPTA was increased in the two groups(P<0.05),and there were no significant differences between groups(P>0.05).There was no significant difference in the incidence rate of complications between the two groups(P>0.05).Conclusion:Open medial tibial osteotomy and closed lateral osteotomy can alleviate the pain of patients with medial compartment of knee OA after operation,correct lower limb line of force,and improve joint varus deformity,and the former has relatively few complications.