两种截骨术治疗膝内侧间室骨关节炎的近期疗效比较

The short-term effect of two osteotomy methods for treatment of medial compartment knee osteoarthritis

目的比较腓骨截骨和内侧开放楔形胫骨高位截骨治疗膝内侧间室骨关节炎的近期临床疗效。方法将40例膝内侧骨关节炎患者按截骨方式的不同分为腓骨截骨组(18例,采用腓骨截骨治疗)与胫骨截骨组(22例,采用内侧开放楔形胫骨高位截骨治疗)。记录术后并发症发生情况和胫骨近端内侧角(MPTA),比较两组术后各时间点疼痛VAS评分、HSS评分。结果患者均获得随访,时间24~28个月。两组术后均未出现切口感染,胫骨截骨组1例脂肪液化,经换药后愈合;腓骨截骨组1例腓深神经牵拉伤,术后3个月完全恢复。VAS评分:术后1周胫骨截骨组高于腓骨截骨组(P<0.05);术后1、3、6、24个月两组比较差异均无统计学意义(P>0.05)。HSS评分:术后1、3、6、24个月两组比较差异均无统计学意义(P>0.05)。MPTA:术后24个月胫骨截骨组优于腓骨截骨组,差异有统计学意义(P<0.05)。结论内侧开放楔形胫骨高位截骨和腓骨截骨治疗膝内侧间室骨关节炎均可有效改善症状,达到治疗目的,两种截骨方式各有优势。

Objective To compare the short-term effect of fibular osteotomy and medial open-wedge high tibial osteotomy(OWHTO)in the treatment of medial compartment knee osteoarthritis.Methods The 40 patients with medial compartment knee osteoarthritis were divided into fibular osteotomy group(18 cases were treated with fibular osteotomy)and tibial osteotomy group(22 cases were treated with OWHTO).The occurrence of postoperative complications and the medial proximal tibial angle(MPTA)were recorded,and the scores of VAS and HSS were compared between two methods at postoperative various time points.Results All patients were followed up for 24~28 months.There was no incision infection in both groups.In OWHTO group,1 case of fat liquefaction healed after dressing change,and 1 case of deep personal nerve stretch injury in fibular osteotomy group recovered completely at 3 months after operation.The VAS:tibia osteotomy group was higher than that of fibula osteotomy group at 1 week after operation(P<0.05),but there was no significant difference between the two groups at 1,3,6,24 months after operation(P>0.05).HSS score:there was no significant difference between the two groups at 1,3,6,24 months after operation(P>0.05).At 24 months after operation,the MPTA of OWHTO group was better than the fibula osteotomy group,and the difference was statistically significant(P<0.05).Conclusions The treatment of knee medial compartment osteoarthritis with OWHTO and fibula osteotomy both can effectively improve the symptoms and achieve the purpose of treatment,each method has its own advantages.