胫骨高位截骨术联合中药热敷治疗膝骨性关节炎合并膝内翻疗效观察

Observation on the curative effect of high tibial osteotomy combined with hot compress of traditional Chinese medicine on knee osteoarthritis with knee varus deformity

目的探讨胫骨高位截骨术联合中药热敷治疗膝骨性关节炎(KOA)合并膝内翻的临床疗效。方法选取2018年4—10月天津医院收治的62例KOA合并膝内翻患者,随机分为对照组和实验组各31例,实验组给予胫骨高位截骨术联合中药热敷治疗,对照组单纯给予胫骨高位截骨术治疗。比较2组治疗前及治疗6周、12周、6个月和12个月后的膝关节疼痛VAS评分、WOMAC骨关节炎指数评分、Lysholm评分、关节活动度(ROM);于术后8周、10周、12周、14周、16周复查X射线片评估截骨处骨折愈合时间;术后12个月入院行内固定取出并行二次关节镜探查,对比2组软骨再生情况。结果所有患者均获随访,2组治疗6周、12周、6个月后VAS评分、骨关节炎指数WOMAC评分、Lysholm评分、ROM均较治疗前明显改善(P均<0.05),同时治疗6周、12周、6个月后实验组WOMAC评分和VAS评分均明显低于对照组(P均<0.05),Lysholm评分和ROM均明显高于对照组(P均<0.05);实验组骨折愈合时间明显短于对照组(P<0.05);术后12个月,实验组镜下软骨再生情况明显优于对照组(P<0.05),但2组WOMAC评分、VAS评分、Lysholm评分及ROM比较差异均无统计学意义(P均>0.05);实验组总有效率为93.6%(29/31),对照组总有效率为80.7%(25/31),实验组明显高于对照组(P<0.05)。结论胫骨高位胫骨术联合中药热敷治疗膝骨性关节炎合并膝内翻,可以有效缓解关节疼痛,恢复关节功能,短期疗效满意,但长期疗效不确定。

Objective It is to explore the clinical effect of high tibial osteotomy(HTO)combined with hot compress of traditional Chinese medicine on knee osteoarthritis(KOA)with knee varus deformity.Methods 62 patients with KOA and knee varus deformity treated in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine and Tianjin Hospital from April 2018 to October 2018 were randomly divided into control group and experimental group:31 patients in the experimental group were treated with HTO combined with hot compress of traditional Chinese Medicine,31 patients in the control group were treated with HTO alone.The VAS scores of knee joint pain,osteoarthritis index WOMAC scores,Lysholm scores and range of motion(ROM)were compared between the two groups before treatment and 6 weeks,12 weeks,6 months and 12 months after treatment.At 8,10,12,14 and 16 weeks after the operation,X-ray was reexamined to evaluate the healing time of the fracture at the osteotomy site;12 months after the operation,they were admitted to the hospital for internal fixation removal followed by a second arthroscopic exploration to compare the cartilage regeneration between the two groups.Results All patients were followed up,the WOMAC scores and VAS scores,Lysholm score and ROM after treatment for 6 weeks,12 weeks and 6 months were significantly improved compared with before treatment in the two groups(P<0.05),the WOMAC scores,VAS scores were significantly lower while the Lysholm scores and ROM were significantly higher in the experimental group than those in the control group(P<0.05);the healing time of fracture in the experimental group was significantly shorter than that in the control group(P<0.05).In 12 months after surgery,the cartilage regeneration under secondary arthroscope in the experimental group was significantly better than that in the control group(P<0.05),but there was no significant difference in WOMAC score,VAS score,Lysholm score and ROM between the two groups(P>0.05).The total effective rate of the experimental group was 93.6%(29/31),which was significantly higher than that 80.7%(25/31)of the control group(P<0.05).Conclusion HTO combined with hot compress of traditional Chinese medicine can effectively relieve joint pain and restore joint function.The short-term follow-up effect is satisfactory,but the long-term effect is uncertain.