腓骨近端截骨对胫骨近端骨密度影响CT值测量研究

Research on the measurement of CT value in the impacts of proximal fibular osteotomy on bone mineral density of proximal tibia

目的探讨膝关节前内侧骨关节炎患者行腓骨近端截骨对胫骨近端骨密度的变化情况。方法将2015年1月至2018年8月在丽水市人民医院行腓骨近端截骨治疗的54例膝关节前内侧骨关节炎患者纳入本研究,观察术前、术后2年膝关节评分、视觉模拟评分、膝关节活动度、髋-膝-踝角和胫骨近端各部位CT值差异。结果(1)与术前相比,术后2年膝关节评分、视觉模拟评分、膝关节活动度、髋-膝-踝角均得到不同程度的改善;(2)术前及术后2年膝关节胫骨近端CT值内侧>外侧>髁间,胫骨近端上层>下层(P<0.05)(除上下层髁间比较);(3)与术前相比,术后2年胫骨近端上层CT值内侧下降,外侧增加,然而近端下层内侧、外侧无明显变化。结论通过对膝关节内侧骨关节炎患者腓骨截骨术前、术后胫骨近端不同层面、不同部位的CT值变化,了解胫骨近端骨密度变化,同时进一步佐证“膝关节不均匀沉降”理论的合理性。

Objective To investigate the changes of bone mineral density of proximal tibia after proximal fibular osteotomy in patients with anterior medial knee osteoarthritis.Methods A total of 54 patients with anterior medial knee osteoarthritis undergoing proximal fibular osteotomy in Lishui City People's Hospital from January 2015 to August 2018 were included in this research.The knee score,visual analogue score,knee range of motion,hip-knee-ankle angle and CT value difference of proximal tibia were observed before and two years after operation.Results(1)Compared with pre-operation,the knee score,visual analogue score,knee range of motion and hip-knee-ankle angle were improved in different degrees 2 years after operation.(2)Before and two years after operation,the CT value of proximal tibia of knee joint was medial>lateral>intercondylar,and proximal tibia was superior>inferior(P<0.05)(except the intercondylar comparison).(3)Compared with preoperative,the CT value of proximal superior tibia decreased on the medial side and increased on the lateral side 2 years after operation,but there was no obvious change on the medial side and lateral side of proximal inferior tibia.Conclusion Through the changes of CT values in different layers and different parts of proximal tibia before and after fibular osteotomy in patients with medial osteoarthritis of knee joint,the changes of bone mineral density in proximal tibia were understood,and the rationality of the theory of"uneven settlement of knee joint"was further proved.