胫骨高位截骨钢板置入联合关节镜治疗伴下肢力线不良的内侧半月板后角退变性损伤

High tibial osteotomy combined with arthroscopy to treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of the knee

背景:既往研究发现,胫骨高位截骨和胫骨高位截骨联合关节镜手术均能够有效治疗合并下肢力线不良的内侧间室骨关节炎,但对比二者治疗效果的研究较少。目的:对比胫骨高位截骨与胫骨高位截骨后钢板置入联合关节镜手术治疗伴下肢力线不良的内侧半月板后角退变性损伤的临床疗效。方法:选择2015年7月至2019年1月遵义医科大学附属医院收治的膝关节骨关节炎患者48例,均伴下肢力线不良的内侧半月板退变性损伤,其中24例接受胫骨高位截骨钢板置入联合关节镜手术(试验组),另24例接受单纯的胫骨高位截骨钢板置入手术(对照组)。比较两组患者术后不同时间点的膝关节功能评分及影像学检测指标。结果与结论:(1)试验组患者术后6,12个月的纽约特种外科医院膝关节评分、膝关节Lysholm评分均高于对照组(P <0.05),两组术后24,36个月的纽约特种外科医院膝关节评分、膝关节Lysholm评分比较差异无显著性意义(P> 0.05);试验组患者术后6个月的目测类比评分低于对照组(P <0.05),两组术后12,24,36个月的目测类比评分比较差异无显著性意义(P> 0.05);(2)术后12个月的影像学检查显示,两组患者的下肢力线与股胫角均得到有效改善,两组间股胫角、下肢力线通过胫骨平台的相对位置、胫骨平台后倾角比较差异均无显著性意义(P>0.05);(3)结果表明,胫骨高位截骨钢板置入及联合关节镜手术均能有效治疗伴下肢力线不良的内侧半月板后角退变性损伤,有效改善患者关节功能、缓解疼痛症状,其中胫骨高位截骨联合关节镜手术治疗的早期临床疗效更好。

BACKGROUND:Previous studies have found that both high tibial osteotomy and high tibial osteotomy combined with arthroscopy can effectively treat medial compartment osteoarthritis with varus deformity of the knee,but there are few studies comparing the therapeutic effects of the two.OBJECTIVE:To compare the clinical outcome of high tibial osteotomy and high tibial osteotomy combined with arthroscopy to treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint.METHODS:From July 2015 to January 2019,data of 48 knee osteoarthritis patients with degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint in Affiliated Hospital of Zunyi Medical University were retrospectively analyzed.The 24 patients in the trial group were treated with high tibial osteoto my combined with arthrosco py.The 24 patients in the control group were treated with high tibial osteotomy.The knee joint function scores and imaging detection indexes at different time points after operation were compared between the two groups.RESULTS AND CONCLUSION:(1) The hospital for special surgery knee score and knee Lysholm score of patients in the trial group at 6 and 12 months after operation were higher than those in the control group(P <0.05).There was no significant difference in the hospital for special surgery knee score and knee Lys holm score between the two groups at 24 and 36 months after operation(P> 0.05).The visual analogue scale score of patients in the trial group was lower than that in the control group at 6 months after surgery(P <0.05).There was no significant difference in the visual analogue scale scores between the two groups at 12,24,and 36 months after surgery(P> 05).(2) The imaging examination at 12 months after operation showed that the lower limb alignment and femoral tibial angle were effectively improved in both groups,and the relative positions of the femoral tibial angle and lower limb alignment passing through the tibial plateau and the posterior tibial slope of the tibial plateau we re not significantly diffe rent between the two groups(P> 0.05).(3) It is concluded that high tibial osteoto my and high tibial osteotomy combined with arthroscopic surge ry can effectively treat degenerative tear in the posterior horn of medial meniscus combined with varus deformity of knee joint,effectively improve joint function and relieve pain symptoms.High tibial osteotomy combined with arthroscopy exhibited good early clinical efficacy.