开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎近期疗效观察

Early effect of open-wedge high tibial osteotomy on medial compartment knee osteoarthritis

目的探讨膝关节内侧间室骨关节炎患者行开放楔形胫骨高位截骨术治疗的近期疗效及安全性。方法膝关节内侧间室骨关节炎患者17例,均行开放楔形胫骨高位截骨术治疗。记录手术时间、术中出血量、住院时间及术后并发症发生情况。术后随访,记录骨折愈合时间,比较术前及术后3个月患侧膝关节内外侧间室高度比、胫股角、疼痛视觉模拟评分(visual analogue scale, VAS)、美国特种外科医院(Hospital for Special Surgery, HSS)膝关节评分、美国膝关节学会评分(Knee Society Score, KSS)。结果 17例患者手术时间(61.2±29.7)min,术中出血量(65.0±21.0)mL,住院时间(9.6±2.7)d,骨折愈合时间(3.2±1.4)个月。术后3个月患侧膝关节内外侧间室高度比(0.37±0.19)大于术前(0.26±0.11)(P<0.05),胫股角[(168.10±2.47)°]小于术前[(179.10±5.20)°](P<0.05),VAS评分[(1.54±0.42)分]低于术前[(7.02±1.41)分](P<0.05),HSS膝关节评分[(80.35±5.01)分]、KSS评分[(82.35±9.39)分]高于术前[(54.28±5.41)、(60.48±8.95)分](P<0.05)。术后未发生下肢血栓、感染或神经损伤等并发症,1例伤口愈合不良者经换药后痊愈。结论开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎创伤小,并发症少,可有效缓解疼痛,改善关节功能,近期疗效满意。

Objective To evaluate the short-term effect of open-wedge high tibial osteotomy(OWHTO) on medial compartment knee osteoarthritis and its safety. Methods Seventeen patients with medial compartment knee osteoarthritis underwent OWHTO. The operation time, intraoperative blood loss, hospital stay and postoperative complications were recorded. The patients were followed up after operation. The fracture healing time was recorded. The height ratio between medial and lateral compartments of knee joint, tibiofemoral angle(FTA), visual analogue scale(VAS) score, Hospital for Special Surgery(HSS) knee score, and the American Knee Society Score(KSS) were compared before and after operation. Results The operation lasted(61.2±29.7) min, the intraoperative blood loss was(65.0±21.0) mL, the length of hospital stay was(9.6±2.7) d, and the fracture healing time was(3.2±1.4) months. The height ratio between medial and lateral compartments of knee joint 3 months after operation(0.37±0.19) was larger than that before operation(0.26±0.11)(P<0.05). The FTA was smaller 3 months after operation((168.1±2.47)°) than that before operation((179.1±5.20)°)(P<0.05). The VAS score was lower 3 months after operation(1.54±0.42) than that before operation(7.02±1.41)(P<0.05). HSS knee score and KSS were higher 3 months after operation(80.35±5.01, 82.35±9.39) than those before operation(54.28±5.41, 60.48±8.95)(P<0.05). No complications occurred such as lower extremity thrombosis, infection or nerve injury. One case of poor wound healing was cured after dressing change. Conclusion OWHTO has less trauma and complications, and can effectively relieve pain and improve joint function in patients with medial compartment knee osteoarthritis, with satisfactory short-term effect.