胫骨高位截骨术结合独活寄生汤加减治疗早中期膝骨性关节炎疗效分析

Analysis of high tibial osteotomy and Duhuo Jisheng Decoction plus or minus to treatment of the prometaphase of knee osteoarthritis

目的探讨应用胫骨高位截骨术联合独活寄生汤加减治疗早中期膝骨关节炎的临床疗效。方法选取2019年1月~2021年1月60例在我院行胫骨高位截骨术的患者,随机分为两组,实验组30例行关节镜清理胫骨内侧高位截骨术并口服独活寄生汤加减治疗,对照组30例行关节镜清理胫骨内侧高位截骨术,所有患者随访至少1年,通过Kellgren-Lawrence(K-L)分级标准评估骨性关节炎放射学改变的严重程度,根据西安大略和麦克玛斯特大学OA指数评分表(WOMAC)对膝关节症状,包括关节疼痛、关节僵硬及功能障碍进行评分,观察其优良率。通过平衡信心(ABC)量表进行评分,记录ABC指数>80%的时间,评价患者术后运动功能恢复情况。结果两组患者术前年龄、体重指数、术前患肢内侧胫骨近端角(MPTA)、VAS评分、K-L分级及WOMAC评分均无差异。两组患者随访至少1年,实验组通过平衡信心指数>80%的平均时间(13.36±1.10)周,对照组(14.27±1.70)周,实验组优于对照组,差异有统计学意义(P<0.05)。术后3个月、6个月及12个月随访,两组患者VAS评分及WOMAC评分术后均较术前明显改善,差异有统计学意义(P<0.05)。术后3个月,患者VAS评分及WOMAC评分实验组优于对照组,差异有统计学意义(P<0.05)。术后6个月及12个月,患者VAS评分及WOMAC评分差异无统计学意义(P>0.05)。结论对于早中期的骨关节炎患者,胫骨高位截骨联合口服独活寄生汤加减对患者的症状及功能改善可获得较好的临床效果,但是对于中远期随访结果相同。

Objective To investigate the clinical effect of high tibial osteotomy and Duhuo Jisheng Decoction plus or minus to treatment of the prometaphase of knee osteoarthritis.Methods Select 60 patients undergoing high tibial osteotomy in our hospital from January 2019 to January 2021 were selected and randomly divided into two groups.In the experimental group,30 patients were performed arthroscopic cleaning and medial tibial high osteotomy,and given Duhuo Jisheng Decoction plus or minus treatment.The control group was treated only by operation.All patients were followed up for at least 1 year.The severity of the radiographic changes in OA was assessed by the Kellgren-Lawrence(K-L)grading criteria.Knee symptoms,including joint pain,joint stiffness and dysfunction,were scored according to the Western Ontario and McMaster Universities OA Index scale(WOMAC)to observe their excellent rates.Patients’recovery of motor function after surgery was evaluated by scoring on the Activities-specific Balance Confidence(ABC)scale and recording the time when the ABC index was>80%.Results There were no differences in preoperative age,body mass index,medial proximal tibial angle(MPTA),VAS score,K-L grade and WOMAC score.The average time of ABC index>80%was(13.36±1.10)weeks in the experimental group and was(14.27±1.70)weeks in the control group.At the follow-up of 3,6 and 12 months after surgery,the VAS score and WOMAC score improved significantly better after surgery,with statistical significance(P<0.05).At three months after operation,the VAS score and WOMAC score of the experimental group were better than those of the control group and the difference was statistically significant(P<0.05).At 6 and 12 months after operation,there was no significant difference in VAS score and WOMAC score(P>0.05).Conclusion For patients with osteoarthritis,high tibial osteotomy combined with Duhuo Jisheng Decoction plus or minus can achieve better clinical results on patients’symptoms and function,but the results are the same for medium and long-term follow-up.