关节镜手术联合矫形支具固定治疗早期膝内侧骨性关节炎的疗效观察

The clinical efficacy of knee arthroscopy combined with orthopedic brace in treatment of early medial knee osteoarthritis

目的观察关节镜手术联合膝关节矫形支具和外侧楔形鞋垫治疗膝内侧骨性关节炎的临床疗效。方法纳入自2018-07—2020-03诊治的40例膝内侧单间室骨性关节炎,观察组20例采用膝关节镜手术联合矫形支具、外侧楔形鞋垫治疗,对照组20例单纯进行膝关节镜手术治疗。比较观察组与对照组术后膝关节疼痛VAS评分与膝关节功能Lysholm评分,以及手术前后固有偏距差值的绝对值。比较合并盘状半月板患者与未合并盘状半月板患者手术前后固有偏距差值的绝对值。结果40例术后均获得12个月随访。观察组术后1、3、12个月膝关节疼痛VAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组与对照组术后1个月膝关节功能Lysholm评分差异无统计学意义(P>0.05);观察组术后3、12个月膝关节功能Lysholm评分高于对照组,差异有统计学意义(P<0.05)。观察组手术前后固有偏距差值的绝对值大于对照组,合并盘状半月板患者手术前后固有偏距差值的绝对值大于未合并盘状半月板患者,差异有统计学意义(P<0.05)。结论膝关节镜手术联合外翻矫形支具与外侧楔形鞋垫治疗早中期膝内侧间室骨性关节炎可改善下肢力线、缓解膝关节疼痛,对于不愿意行截骨矫形、膝关节置换以及无法耐受手术的患者来说是一种较好的选择。

Objective To observe the clinical efficacy of arthroscopic surgery combined with knee orthopedic braces and lateral wedge insoles in the treatment of medial knee osteoarthritis.Methods Forty cases of medial knee single-compartment osteoarthritis were included from July 2018 to March 2020.The observation group(20 cases)was treated with knee arthroscopy combined with orthopedic braces and lateral wedge insoles,and the control group(20 cases)was treated with knee arthroscopy alone.The VAS score of knee joint pain,Lysholm score of knee joint function,and the absolute value of the intrinsic varizing distance(IVD)before and after the operation were compared between the observation group and the control group.The IVD absolute value of the difference between the patients with discoid meniscus and those without discoid meniscus before and after the operation was compared.Results All 40 cases were followed up after operation for 12 months.The VAS score in the observation group was lower than that in the control group at 1,3,and 12 months after surgery,and the difference was statistically significant(P<0.05).There was no significant difference in the Lysholm score of knee joint function between the observation group and the control group one month after operation(P>0.05).The Lysholm score of knee joint function in the observation group was higher than that in the control group at 3 and 12 months after operation,and the difference was statistically significant(P<0.05).The IVD absolute value of the difference between the observation group after the operation was greater than that of the control group,and the IVD absolute value of the difference between the patients with discoid meniscus after the operation was greater than that of the patients without discoid meniscus,the difference was statistically significant(P<0.05).Conclusion Knee arthroscopic surgery combined with valgus orthopedic brace and lateral wedge-shaped insole for the treatment of osteoarthritis of the medial compartment of the knee in the early and mid-term can improve the force line of the lower limbs and significantly relieve the pain of the knee joint.For patients who are unwilling to undergo osteotomy,orthopedic surgery,knee replacement surgery,and patients who cannot tolerate major surgical trauma,this type of treatment is a better choice.