内侧开放楔形胫骨高位截骨术治疗膝关节内翻畸形的疗效及对术后下肢力线和创伤应激的影响

Efficacy of Medial Open Wedge High Tibial Osteotomy on Knee Joint Varus Deformity and its Effect on the Postoperative Lower Limbs Force Line and Traumatic Stress

目的:对比内侧开放楔形胫骨高位截骨术(OWHTO)、人工全膝关节置换术(TKA)治疗膝关节内翻畸形的疗效及对术后下肢力线和创伤应激的影响。方法:回顾性分析贵州医科大学附属医院2020年3月~2022年1月期间接收的膝关节内翻畸形患者临床资料,共计75例。根据手术方案的不同分为OWHTO组(n=40)和TKA组(n=35)。对比两组围术期指标、视觉疼痛模拟评分(VAS)评分、美国特种外科医院(HSS)膝关节评分、膝关节活动度(ROM)、应激指标和术后下肢力线改变情况。结果:OWHTO组手术时间、切口长度短于TKA组,术中出血量、住院费用少于TKA组(P<0.05)。OWHTO组术后1个月VAS评分低于TKA组,ROM、HSS膝关节评分高于对照组(P<0.05)。OWHTO组术后3 d、术后7 d血清皮质醇(COR)、促肾上腺皮质激素(ACTH)水平低于TKA组(P<0.05)。两组术后6个月股胫角(FTA)下降,髋-膝-踝角(HKA)升高(P<0.05)。两组术后6个月FTA、HKA组间对比差异不显著(P>0.05)。两组并发症发生率组间对比未见差异(P>0.05)。结论:OWHTO、TKA这两种治疗方案治疗膝关节内翻畸形,具有相当的疗效,均可有效改善下肢力线,但OWHTO的创伤小、应激程度轻。

Objective:To compare the efficacy of medial open wedge high tibial osteotomy(OWHTO)and total knee arthroplasty(TKA)in the treatment of knee joint varus deformity and the effect on the postoperative lower limbs force line and traumatic stress.Methods:The clinical data of patients with knee joint varus deformity who were received in Affiliated Hospital of Guizhou Medical University from March 2020 to January 2022 were retrospectively analyzed,75 cases in total.They were divided into OWHTO group(n=40)and TKA group(n=35)according to different surgical schemes.The perioperative indexes,visual pain analogue scale(VAS)score,American hospital for special surgery(HSS)knee score,knee range of motion(ROM),stress indexes and changes of postoperative lower limbs force line were compared between the two groups.Results:The operation time and incision length in the OWHTO group were shorter than those in the TKA group,and the amount of intraoperative bleeding and hospitalization expenses were less than those in the TKA group(P<0.05).1 month after operation,the VAS score in the OWHTO group was lower than that in the TKA group,and the ROM and HSS knee score in the OWHTO group were higher than those in the control group(P<0.05).The levels of serum cortisol(COR)and adrenocorticotropic hormone(ACTH)in the OWHTO group were lower than those in the TKA group at 3 d after operation and 7 d after operation(P<0.05).The femoral tibial angle(FTA)decreased and the hip knee ankle angle(HKA)increased in the two groups at 6 months after operation(P<0.05).There were no significant differences between FTA and HKA in the two groups at 6 months after operation(P>0.05).There was no difference in the incidence of complications between the two groups(P>0.05).Conclusion:OWHTO and TKA have considerable therapeutic effects in the treatment of knee joint varus deformity,both of which can effectively improve the lower limbs force line,but OWHTO has little trauma and light stress degree.