单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的效果观察

Effect of Single Condyle Replacement and High Tibial Osteotomy in the Treatment of Medial Compartment Osteoarthritis of the Knee

目的:比较单髁置换术与胫骨高位截骨术(HTO)治疗膝关节内侧间室骨关节炎的临床效果。方法:选取2018年1月-2019年3月本院收治的膝关节内侧间室骨关节炎患者70例。按照系统随机抽样方法将患者随机分为对照组(n=35)和观察组(n=35)。对照组予以胫骨高位截骨手术治疗,观察组予以单髁置换术治疗,术后对患者进行为期1年的随访。比较两组患者的手术相关指标、临床疗效以及并发症发生情况。结果:观察组术中出血量明显少于对照组,术后24 h VAS评分明显低于对照组,止血带使用时间短于对照组,差异均有统计学意义(P<0.05);两组手术时间比较,差异均无统计学意义(P>0.05)。术后1年,两组的Lysholm膝关节评分、膝关节屈曲角度以及膝关节Tegner运动评分均高于术前,差异均有统计学意义(P<0.05)。术后1年,两组Lysholm膝关节评分、膝关节Tegner运动评分比较,差异均无统计学意义(P>0.05);术后1年,观察组膝关节屈曲角度大于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:单髁置换术与胫骨高位截骨术在膝关节内侧间室骨关节炎的临床治疗中均具有较好的近期效果,临床选择术式时应对患者的畸形程度、年龄、运动功能期望值等因素进行综合评估,遵循个体化原则进行选择。

Objective:To compare the clinical effects of single condylar replacement and high tibial osteotomy (HTO) in the treatment of knee medial compartment osteoarthritis.Method:A total of 70 patients with knee medial compartment osteoarthritis treated in our hospital from January 2018 to March 2019 were selected.The patients were randomly divided into control group (n=35) and observation group (n=35).The control group was treated with high tibial osteotomy and the observation group was treated with single condylar replacement,the patients were followed up for 1 year.The operation related indexes,clinical efficacy and complications of the two groups were compared.Result:The intraoperative blood loss in the observation group was significantly less than that in the control group,the VAS score at 24 h after operation was significantly lower than that in the control group,the use time of tourniquet was shorter than that of the control group,the differences were statistically significant (P<0.05).Comparison of the operation time of the two groups,there was no significant difference (P>0.05).1 year after operation,the Lysholm knee score,knee flexion angle and knee Tegner motion score of the two groups were higher than those before operation,the differences were statistically significant (P<0.05).1 year after operation,comparison of Lysholm knee score and Tegner knee motion score between the two groups,there were no significant differences (P>0.05).1 year after operation,the knee flexion angle in the observation group was greater than that in the control group,the difference was statistically significant (P<0.05).Comparison of the incidence of complications between the two groups,there was no significant difference (P>0.05).Conclusion:Single condylar arthroplasty and high tibial osteotomy have good short-term effects in the clinical treatment of medial compartment osteoarthritis of the knee.When selecting the operation method,we should comprehensively evaluate the degree of deformity,age,motor function expectation and other factors of the patient,and follow the individualized principle.