高位胫骨截骨联合镜下半月板后根缝合治疗内翻型膝关节炎的初步临床报告

A Pilot Study of High Tibial Osteotomy Combined With Endoscopic Meniscus Posterior Root Suturing in the Treatment of Varus Knee Osteoarthritis

目的评估高位胫骨截骨(high tibial osteotomy,HTO)结合镜下半月板后根(meniscus posterior root,MPR)缝合术对中老年患者内翻型膝关节炎的短期疗效。方法2018年2月~2019年3月,对17例合并内侧半月板后根撕裂(medial meniscus posterior root tear,MMPRT)的中老年内翻型膝关节炎行HTO+MPR全内缝合术。术前和术后1、2年随访进行下肢全长X线摄影和MRI,观察膝内翻角度,半月板外突情况,软骨形态全膝MRI评分(Whole-Organ Magnetic Resonance Imaging Score,WORMS)-骨髓水肿分级,Lysholm膝关节评分,膝关节损伤和骨关节炎评分(Knee Injury and Osteoarthritis Outcome Score,KOOS)。结果手术均顺利完成,无并发症发生。除1例失访,16例完成2年随访。术后1年、2年膝内翻角度(3.5°±2.1°、4.1°±2.1°)均较术前(14.6°±3.6°)显著降低(均P=0.000)。术前MRI示半月板外突11例,术中均矫正,术后1年、2年各有1例发生内侧半月板外突。术前WORMS-骨髓水肿分级0级2例,1级7例,2级5例,3级3例;术后1年0级9例,1级6例,2级1例;术后2年0级11例,1级5例。术后1年、2年的Lysholm评分、KOOS各项均较术前明显改善。结论HTO+镜下MPR缝合术治疗合并MMPTR的中老年内翻型膝关节炎,可显著改善疼痛等症状,提高日常生活能力、运动能力及生活质量。

Objective To evaluate the short-term outcome of high tibial osteotomy(HTO)combined with endoscopic meniscus posterior root(MPR)suturing for varus knee osteoarthritis(KOA)concomitant with medial meniscus posterior root tears(MMPRT)in middle aged elderly patients.Methods A total of 17 middle aged elderly patients who underwent HTO combined with endoscopic MPR suturing from February 2018 to March 2019 in our hospital were included.The lower extremity X-ray and knee MRI were performed in pre-operation and at 1 and 2 year follow-ups to estimate the knee varus angle,meniscus protrusion,the Whole-Organ Magnetic Resonance Imaging Score(WORMS)-Bone Marrow Edema Score,as well as the Lysholm Score and Knee Injury and Osteoarthritis Outcome Score(KOOS).Results The combined operations were smoothly completed without complications.Except 1 case lost follow-up,16 cases completed 2-year follow-ups.The knee varus angle was significantly reduced at 1 year(3.5°±2.1°)and 2 years(4.1°±2.1°)follow-ups than before operation(14.6°±3.6°)(all P=0.000).Pre-operative MRI showed the meniscus protrusion in 11 patients,which were corrected during the operation.There were 1 case of meniscus protrusion occurred at 1 year and 1 case at 2 years follow-ups.The MRI showed WORMS grade 0 in 2 cases,grade 1 in 7 cases,grade 2 in 5 cases,grade 3 in 3 cases pre-operatively,and grade 0 in 9 cases,grade 1 in 6 cases,grade 2 in 2 cases at 1 year follow-up,as well as grade 0 in 11 cases,grade 1 in 5 cases at 2 years follow-up.The Lysholm and all KOOS scores were significantly improved at 1 and 2 years in post-operation than pre-operation.Conclusion The short-term outcome of the HTO combined with endoscopic MPR suturing is satisfactory.It can notably relieve the pain and discomfort symptoms,improve daily living ability,sport function,and life quality in middle aged elderly patients.