胫骨截骨联合关节镜治疗内侧室膝骨关节炎

High tibial osteotomy distal to tibial tuberosity combined with arthroscopic debridement for medial compartment knee osteoarthritis

[目的]比较胫骨截骨术联合关节镜治疗与单纯关节镜治疗内侧间室膝骨关节炎的临床效果。[方法]回顾分析2016年8月~2018年10月手术治疗的内侧间室膝骨关节炎患者133例;其中,65例采用关节镜清理联合胫骨截骨,68例采用单纯关节镜清理术。比较两组围手术期、随访和影像资料。[结果]所有患者均顺利完成手术,无神经、血管损伤等严重并发症。两组患者镜下所见内侧间室Outerbridge分级和镜下操作的差异无统计学意义(P>0.05)。随时间推移,两组患者VAS评分和WOMAC评分均显著减少(P<0.05),而HSS评分显著增加(P<0.05)。术后3个月和12个月时,联合组的上述评分均显著优于关节镜组(P<0.05)。影像方面,联合组术后12个月WBL和FTA均较术前显著改善,而关节镜组的WBL和FTA无变化(P>0.05);术后12个月,联合组WBL、FTA显著优于关节镜组(P<0.05)。[结论]胫骨截骨术联合关节镜清理治疗内侧室膝骨性关节炎的临床效果显著优于单纯关节镜清理术。

[Objective] To compare the clinical outcomes of high tibial osteotomy distal to tibial tuberosity combined with arthroscopic debridement versus arthroscopic debridement only for medial compartment knee osteoarthritis. [Methods] A retrospective study was conducted on a total of 133 patients who underwent knee preserving surgical treatment for medial compartment knee osteoarthritis in our hospital from August 2012 to October 2018. Of them, 65 patients received open-wedge high tibial osteotomy distal to the tibial tuberosity combined with arthroscopic debridement, while the remaining 68 patients had arthroscopic debridement only. The perioperative, follow-up and radiographic documents were compared between the two groups.[Results] All the 133 patients had operation performed smoothly without serious complications. There were no statistically significant differences in Outerbridge classification for pathology of the medical compartment and arthroscopic interferences between the two groups(P>0.05). The VAS and WOMAC scores significantly decreased, whereas HSS score significantly increased over time in both groups(P<0.05). The combined group proved significantly superior to the arthroscopic group regarding to the aforesaid scores at 3 and 12 months postoperatively(P<0.05). With regard to radiographic assessment, the weight bearing line(WBL) and femorotibial angle(FTA) significantly improved in the combined group at 12 months after operation compared with those before operation(P<0.05), whereas remained unchanged in the arthroscopic group(P>0.05). The combined group proved significantly superior to the arthroscopic group in WBL and FTA at 12 months after operation(P<0.05). [Conclusion] For knee preserving surgical treatment of the medial compartment knee osteoarthritis, the open-wedge high tibial osteotomy distal to the tibial tuberosity combined with arthroscopic debridement is considerably superior to the arthroscopic debridement only in clinical outcomes.