胫骨高位开放截骨并微骨折术联合富血小板血浆植入治疗膝内侧间室骨关节炎的短期疗效研究

Short-term efficacy of opening wedge high tibia osteotomy combined with microfracture and platelet rich plasma in treatment of medial unicompartmental knee osteoarthritis

目的:探讨胫骨高位开放截骨并微骨折术联合富血小板血浆(PRP)植入治疗膝内侧间室骨关节炎的临床疗效。方法:回顾性分析2018年2月至2019年10月我院收治的膝关节内侧间室骨关节炎患者41例(41膝)。分别于术前、术后6个月、术后12个月对患者进行疼痛视觉模拟评分(VAS)、Lysholm评分、美国特种外科医院膝关节功能评分(HSS),并测量胫骨近端内侧角(MPTA)和机械轴股胫角(mFTA)。结果:41例患者均行关节镜下清理+微骨折术、胫骨高位开放截骨联合富血小板血浆植入。所有患者均获得至少12个月随访,最长随访时间30个月,平均随访时间(16.3±4.2)个月。术后6个月、12个月VAS评分、Lysholm评分及HSS评分均较术前有显著改善(P<0.01),术后12个月上述3项评分较术后6个月时无明显变化(P>0.05)。术后6个月、12个月MPTA、mFTA均较术前有显著改善(P<0.01),术后12个月上述角度较术后6个月时无明显变化(P>0.05)。术后6个月优良率为100%。所有病例切口愈合良好,术后6个月随访时截骨处全部达骨性愈合,未出现血管神经损伤、感染、下肢深静脉血栓形成、内植物排异、内固定松动断裂、再骨折等并发症。结论:胫骨高位开放截骨并微骨折术联合PRP植入治疗膝内侧间室骨关节炎能有效调整并固定下肢力线,促进骨愈合,延缓膝关节退变,短期临床疗效满意,但远期疗效还需进一步观察。

Objective: To explore the clinical efficacy of opening wedge high tibial osteotomy(OWHTO) combined with arthroscopic microfracture and platelet rich plasma(PRP) injections in treatment of patients with medial unicompartmental knee osteoarthritis. Methods: Totally 41 patients who suffered symptomatic medial unicompartmental knee osteoarthritis underwent OWHTO combined with arthroscopic microfracture and PRP injections in our hospital from February 2018 to October 2019.The visual analogue scale(VAS), Lysholm score and hospital for special surgery(HSS) knee score were used to evaluate the clinical outcomes and the medial proximal tibial angle(MPTA) and mechanical femorotibial angle(mFTA) were observed and gauged preoperatively, 6 and 12 months postoperatively. Results: All 41 patients were followed up for 12~30 months, with an average of(16.3±4.2) months. The postoperative scores of the VAS, Lysholm and HSS were improved compared with those of preoperative ones(P<0.01). The differences between 6 and 12 months postoperatively in both VAS, Lysholm and HSS sores had no statistical significance(P>0.05). MPTA and m FTA were improved obviously at 6 and 12 months after operation compared with that before operation(P<0.01). There were no significant difference in MPTA and m FTA at 6 and 12 months after surgery(P>0.05). The rates of excellent and good results were 100% at 6 months after the surgery. All patients had good incision healing. Bony fusion was achieved in all patients 6 months postoperatively. No such complications as neurovascular injury, infection, deep vein thrombosis of the lower extremity, implant rejection, internal fixation loosening and broken and refracture occurred during the follow-up period. Conclusions: OWHTO combined with arthroscopic microfracture and PRP injections leads to a satisfying short-term clinical outcome in patients with medial unicompartmental knee osteoarthritis, with lower extremity alignment adjusted and fixed, bony fusion achieved and knee regression delayed. However, the long-term efficacy needs to be further observed.