三种微创术式治疗内侧型膝骨关节炎的疗效比较

Comparison of Three Minimally Invasive Surgical Procedures on Medial Knee Osteoarthritis

目的:回顾性研究三种不同微创术式治疗内侧型膝骨关节炎(KOA)的临床疗效及对膝关节力线的影响。方法:按采用的术式将纳入的176例内侧型KOA患者分为腓骨近端截骨术组(A组)59例、腓骨近端截骨术+关节镜清理术组(B组)49例和关节镜清理术组(C组)68例,比较各组术后不同时间点患膝活动度(ROM)、美国纽约特种外科医院评分(HSS)、生活质量评分(SF-36)、疼痛视觉模拟评分(VAS)、胫骨平台内翻角、内外间隙比及并发症情况。结果:术后平均随访3.89年(2.0~5.9年)。术后3个月B,C组ROM,VAS,HSS,SF-36评分较A组差异有统计学意义(P<0.01),胫骨平台内翻角、内外间隙比差异无统计学意义(P>0.05);术后1年A组和B组ROM,VAS,HSS,SF-36评分较术前改善,且较C组差异有统计学意义(P<0.05),胫骨平台内翻角、内外间隙比差异无统计学意义(P>0.05);术后2年A组和B组ROM,VAS,HSS,SF-36评分较术前改善,且较C组差异有统计学意义(P<0.01),A组和B组间比较差异无统计学意义(P>0.05),胫骨平台内翻角、内外间隙比较C组差异有统计学意义(P<0.05)。治疗期间27例出现局部肿胀,经对症处理后在1个月内消退;A组和B组各出现4例和3例足背麻木感和感觉减退,给予对症治疗3~6个月后恢复。结论:关节镜清理术和关节镜清理术+膝关节近端截骨术治疗内侧型KOA早期疗效显著;腓骨近端截骨术和腓骨近端截骨术+关节镜清理术治疗较单纯关节镜清理在早期、中期都取得较为满意的疗效,腓骨截骨术还能部分调整膝关节力线,减轻患者膝关节内侧疼痛感,改善膝关节功能,得到较好的中期临床疗效,提高了患者生活质量,在临床上应结合患者病情不同阶段灵活应用。

Objective:To retrospectively study the clinical efficacy of three different minimally invasive surgical procedures in treating medial knee osteoarthritis(KOA) and the effect on the knee joint line of force.Methods:According to the measures of treatment,176 patients with medial KOA were divided into the proximal fibula osteotomy group(group A) with 59 cases,the proximal fibula osteotomy + arthroscopy group(group B) with 49 cases and arthroscopic debridement group(group C) with 68 cases.The knee range(Range of Motion,ROM),Hospital for Special Surgery of New York(HSS),Quality of Life Score(Short Form 36 Questionnaire(SF-36)),Visual Analogue Scale(VAS) of pain,tibial plateau varus angle,internal and external space ratio and complications were documented and compared at different time points in each group.Results:The average follow-up was 3.89(2.0~5.9) years.The ROM,VAS,HSS,and SF-36 scores of group B and C at 3 months after surgery were significantly different from those of group A(P<0.01),and there was no statistical difference in the tibial plateau varus angle and the ratio of internal and external space(P>0.05).The ROM,VAS,HSS,and SF-36 scores of group A and group B were improved 1 year after operation as compared with those before operation,and there were statistical differences as compared with group C(P<0.05).No statistical difference was found in the tibial plateau varus angle internal and external space ratio(P>0.05).The ROM,VAS,HSS,and SF-36 scores of group A and group B improved 2 years after surgery,and there were significant statistical differences from group C(P<0.01).There was no difference between group A and B(P>0.05).The tibial plateau inversion angle and internal and external space were statistically different between group C and others(P<0.05).27 cases of local swelling happened in all,and 4 cases in group A,3 cases in group B experienced numbness and sensation in the back of the feet.They were recovered after treatment.Conclusion:Joint debridement only and joint debridement with proximal knee osteotomy are effective in the early treatment of medial-type KOA.Proximal fibula osteotomy,proximal fibula osteotomy combined with arthroscopic debridement are more effective in the early stage than arthroscopy.Satisfactory curative effects have been achieved in the middle and mid-term.Fibula osteotomy can also partially adjust the knee joint line of force,which can reduce the pain of the medial knee joint,improve knee function,and obtain better mid-term clinical effects,improve the quality of life of patients.Clinically,it should be flexibly applied in different stages of the patient’s condition.