两种截骨方法联合关节镜治疗内侧膝骨关节炎的早期疗效分析

Efficacy Analysis of Different Osteotomy Methods Combined with Arthroscopy in the Treatment of Medial Knee Osteoarthritis

目的探讨不同截骨方法联合关节镜治疗内侧膝骨关节炎的疗效。方法选取2019年1月至2021年1月河北省第八人民医院124例内侧膝骨关节炎患者,按随机数字表法分为双平面组(62例)和单平面组(62例),两组均行关节镜+胫骨高位截骨术(high tibial osteotomy,HTO),双平面组采取双平面截骨,单平面组采取单平面截骨。统计两组围手术期指标、并发症、膝关节功能恢复优良率,比较术前、术后6个月下肢力线相关指标[膝关节内翻角(knee varus angle,KVA)、股胫角(femur tibia angle,FTA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)]、美国特种外科医院膝关节评(hospital for special surgery knee score,HSS)、疼痛视觉模拟评分(visual analogue scale,VAS)。结果(1)术后6个月双平面组骨性愈合时间短于单平面组(P<0.05);(2)术后6个月双平面组MPTA高于单平面组,FTA、KVA低于单平面组(P<0.05);(3)术后6个月双平面组HSS评分高于单平面组,VAS评分低于单平面组(P<0.05);(4)双平面组并发症发生率1.61%与单平面组8.06%比较,差异无统计学意义(P>0.05);(5)术后6个月双平面组膝关节功能恢复优良率88.71%高于单平面组的74.20%(P<0.05)。结论关节镜联合双平面截骨在膝关节功能、疼痛评分、下肢力线、骨折愈合方面改善效果优于关节镜联合单平面截骨,可作为治疗内侧膝骨关节炎的有效手段之一。

Objective To investigate the efficacy of different osteotomy methods combined with arthroscopy in the treatment of medial knee osteoarthritis.Methods A total of 124 patients with medial knee osteoarthritis in the Eighth People's Hospital of Hebei Province from January 2019 to January 2021 were selected and randomly divided into a double plane group(n=62)and a single plane group(n=62).Both groups underwent arthroscopy and high tibial osteotomy(HTO).The biplane group underwent biplane osteotomy,and the single plane group underwent single plane osteotomy.All patients were followed up for 6 months.The perioperative indicators,complications and the excellent and good rate of knee joint function recovery of the two groups were counted and compared the relevant indexes of lower limb force line,including knee varus angle(KVA),femoral tibia angle(FTA),medial proximal tibial angle(MPTA),American hospital for special surgery knee score(HSS),and visual analogue scale(VAS)before and 6 months after surgery.Results(1)Follow-up of 6 months showed that the bone healing time of the biplane group was shorter than that of the single plane group(P<0.05).(2)The MPTA of the biplane group was higher than that of the single plane group,and the FTA and KVA of the biplane group were lower than those of the single plane group at 6 months after operation(P<0.05).(3)The HSS score of the biplane group was higher than that of the single plane group at 6 months after operation,and the VAS score was lower than that of the single plane group(P<0.05).(4)The complication rate of the biplane group was 1.61%,and the single plane group’s complication rate was 8.06%.The difference was not statistically significant(P>0.05).(5)The excellent and good rate of knee function recovery in the biplane group(88.71%)was higher than that in the single plane group(74.20%)at 6 months after operation(P<0.05).Conclusion Arthroscopic combined with biplane osteotomy is superior to arthroscopy combined with single plane osteotomy in improving knee joint function,pain score,lower limb force line and fracture healing.It can be used as one of the effective method to treat medial knee osteoarthritis.