胫骨高位截骨术与腓骨截骨术治疗膝骨关节炎临床疗效比较

Clinical efficacy comparison of high tibial osteotomy and fibula osteotomy in the treatment of knee osteoarthritis

目的比较胫骨高位截骨术与腓骨截骨术治疗膝骨关节炎临床疗效。方法选择2017年6月~2018年6月在我院诊断治疗的膝内侧间室骨性关节炎患者60例的临床资料进行回顾性分析,其中30例患者采用胫骨高位截骨术治疗为胫骨截骨术组,30例采用腓骨截骨术治疗为腓骨截骨术组。术前与术后4周采用日本骨科学会膝关节功能评价标准(JOA)对近期疗效进行评价,术前及术后6个月采用膝关节Lysholm评分对患者膝关节功能康复情况进行评价。结果(1)术后4周,JOA评分较术前显著改善,差异有统计学意义(P<0.05);术后4周,胫骨截骨术组JOA评分显著高于腓骨截骨术组,差异有统计学意义(P<0.05)。(2)两组术后6个月Lysholm总分均显著提高,与术前比较,差异有统计学意义(P<0.05);术后6个月,胫骨截骨术组Lysholm总分显著高于腓骨截骨术组,差异有统计学意义(P<0.05)。(3)腓骨截骨术组手术时间显著短于胫骨截骨术组,术中出血量显著少于胫骨截骨术组,住院费用显著低于胫骨截骨术组,差异有统计学意义(P<0.05)。结论胫骨高位截骨术与腓骨截骨术治疗膝骨关节炎均能改善膝关节功能。胫骨截骨术治疗膝骨关节炎的总体效果要优于腓骨截骨术,但是后者创伤更小,手术时间更短,费用更低,临床上对于合并症较多,手术耐受力较差的患者,可优先选择腓骨截骨术。

Objective To compare the clinical efficacy of high tibial osteotomy and fibula osteotomy in the treatment of knee osteoarthritis.Methods The clinical data of 60 patients with medial knee osteoarthritis diagnosed and treated in our hospital from June 2017 to June 2018 were selected and retrospectively analyzed.30 patients were treated with high tibial osteotomy,and were set as tibial osteotomy group.30 patients were treated with fibula osteotomy,and were set as fibula osteotomy group.The knee joint function evaluation criteria of the Japanese Orthopaedic Association(JOA)was used to evaluate the short-term efficacy before and 4 weeks after surgery.The knee joint Lysholm score was used to evaluate knee function rehabilitation of patient before and 6 months after surgery.Results(1)The JOA score at 4 weeks after surgery was significantly improved compared with that before surgery,and the difference was statistically significant(P<0.05).At 4 weeks after surgery,the JOA score of tibial osteotomy group was significantly higher than that of the tibial osteotomy group,and the difference was statistically significant(P<0.05).(2)The total Lysholm score at 6 months after surgery was significantly higher than that before surgery,and the difference was statistically significant(P<0.05).The total Lysholm score at 6 months after surgery in the tibial osteotomy group was significantly higher than that in the tibial osteotomy group,and the difference was statistically significant(P<0.05).(3)The operation time of the fibula osteotomy group was significantly shorter than that of the tibial osteotomy group,the intraoperative bleeding volume was significantly less than that of the tibial osteotomy group,and the hospitalization cost was significantly lower than that of the tibial osteotomy group.The differences were statistically significant(P<0.05).Conclusion High tibial osteotomy and fibula osteotomy can both improve knee joint function in the treatment of knee osteoarthritis.The overall effect of tibial osteotomy for knee osteoarthritis is better than fibula osteotomy,but the latter has less trauma,shorter operation time,and lower cost.Therefore,for patients with many comorbidities and poor surgical tolerance,fibula osteotomy can be preferred.