关节镜在开放性胫骨高位截骨术中的应用效果

Application of Arthroscopy in Open High Tibial Osteotomy

目的探讨在开放性胫骨高位截骨术(HTO)中使用关节镜行关节腔内操作的效果。方法将内侧间隙膝关节骨性关节炎患者30例(共30膝)按随机数字表法分为对照组与观察组,每组15例。对照组单纯行HTO术,观察组在行HTO术中采用膝关节镜处理关节腔。比较2组骨愈合时间,观察2组术前及术后3、6、9个月疼痛评分(VAS评分)、膝关节功能评分(HSS评分)的变化情况。结果 2组骨愈合时间比较差异无统计学意义(P>0.05)。2组术后各时段VAS评分均较术前显著降低(P<0.05),HSS评分均较术前显著升高(P<0.05);观察组术后3个月VAS评分明显低于对照组(P<0.05),术后6个月、9个月2组VAS评分比较差异无统计学意义(P>0.05);观察组术后3、6个月HSS评分高于对照组(P<0.05),术后9个月2组HSS评分比较差异无统计学意义(P>0.05)。结论 HTO联合膝关节镜处理关节腔治疗膝关节骨性关节炎短期内可以有效地缓解术后疼痛、促进患膝功能恢复,虽对远期功能预后价值不大,但对患者就医体验改善明显。

Objective To investigate the efficacy of arthroscopic intra-articular operation in open high tibial osteotomy(HTO).Methods Thirty patients with medial knee osteoarthritis(30 knees) were randomly given HTO alone(control group,n=15) or in combination with arthroscopic intra-articular treatment(observation group,n=15).Bone healing time was compared between the two groups.In addition,the pain(VAS score) and knee function(HSS score) were measured before and 3,6 and 9 months after operation.Results There was no significant difference in bone healing time between the two groups(P>0.05).After treatment,VAS score decreased and HSS score increased in both groups(P<0.05).Compared with control group,VAS score decreased at 3 months after operation and HSS score increased at 3 and 6 months after operation in observation group(P<0.05).There were no statistical differences between the two groups in VAS score at 6 and 9 months after operation,as well as in HSS score at 9 months after operation(P>0.05).Conclusion HTO combined with arthroscopic intra-articular treatment can effectively relieve postoperative pain and promote the recovery of knee function in patients with knee osteoarthritis.Although the combined treatment has little value for long-term functional prognosis,it can obviously improve the patient’s medical experience.