膝关节骨关节炎患者经腓骨截骨术联合关节镜下膝关节清理术治疗的效果评价

Effect evaluation of peroneal osteotomy combined with arthroscopic knee debridement in patients with knee osteoarthritis

目的评价腓骨截骨术联合关节镜下膝关节清理术对膝关节骨关节炎患者围手术期指标、X线片指标、日本骨科协会评估治疗分数(JOA评分)、美国特种外科医院膝关节评分(HSS评分)、并发症发生率的影响。方法采用前瞻性研究的方法,选取2016年4月至2021年4月承德市中心医院收治的110例膝关节骨关节炎患者作为研究对象,以随机数字表法分为对照组(55例)、联合组(55例),对照组行关节镜下膝关节清理术,联合组在对照组的基础上,联合腓骨截骨术,两组术后随访6个月。比较两组围手术期指标,治疗前、治疗1个月后的JOA评分,治疗前、治疗6个月后的X线片指标、HSS评分、随访期间并发症发生率。结果联合组手术时间长于对照组[(84.36±14.64)min比(75.88±12.86)min];相比于术前,术后1个月,两组肿胀程度、上下楼梯疼痛、步行疼痛、关节活动度评分升高,联合组高于对照组[(8.35±0.73)分比(6.74±0.67)分、(15.05±1.74)分比(13.96±1.66)分、(21.75±2.07)分比(18.58±1.73)分、(27.59±3.25)分比(25.74±2.83)分];术后6个月,两组胫骨关节间隙角变小,联合组小于对照组[(1.94±0.60)°比(3.02±0.67)°];两组股骨胫骨角、膝关节活动度变大,联合组大于对照组[(190.95±5.43)°比(186.64±4.68)°、(92.60±8.81)°比(83.26±8.54)°];两组稳定性、屈曲畸形、肌力、活动度、功能、疼痛评分升高,联合组高于对照组[(8.62±0.86)分比(6.89±0.78)分、(7.86±0.96)分比(6.27±0.68)分、(7.79±0.62)分比(6.95±0.57)分、(14.95±2.60)分比(12.48±2.33)分、(17.46±2.21)分比(14.59±1.76)分、(24.83±3.25)分比(18.59±2.57)分],差异均有统计学意义(P<0.05);随访期间,两组骨筋膜间隔室综合征、神经血管损伤、膝关节内粘连及切口感染的发生率比较差异无统计学意义(P>0.05)。结论膝关节骨关节炎患者行腓骨截骨术联合关节镜下膝关节清理术的手术时间较长,但腓骨截骨术联合关节镜下膝关节清理术可减轻患者关节外翻情况,提高关节活动度,可有效减轻疼痛程度,改善膝关节功能,其安全性良好,有较好的治疗效果。

Objective To evaluate the effects of peroneal osteotomy combined with arthroscopic knee debridement on perioperative indexes,X-ray indexes,Japanese Orthopaedic Association Assessment score(JOA score),American Hospital for Special Surgery knee score(HSS score)and complication rate of patients with knee osteoarthritis.Methods A prospective research method was adopted.A total of 110 patients with knee osteoarthritis who were admitted to Chengde Central Hospital from April 2016 to April 2021 were selected as the research objects and divided into the control group(55 cases),the combined group(55 cases)by random number table method.The control group underwent arthroscopic debridement of the knee joint.On the basis of the control group,the combined group was combined with fibula osteotomy.The control group and the combined group were followed up for 6 months after operation.The perioperative indicators,score of JOA before and after 1 month of treatment,X-ray indicators,score of HSS before and after 6 months of treatment,and the incidence of complications during the follow-up period were compared between the control group and the combined group.Results The operation time of the combined group was longer than that of the control group:(84.36±14.64)min vs.(75.88±12.86)min;compared with before operation,1 month after operation,the scores of swelling,pain while up and down stairs,walking pain,joint range of motion were increased in the control group and the combined group,and the combined group was higher than the control group:(8.35±0.73)points vs.(6.74±0.67)points,(15.05±1.74)points vs.(13.96±1.66)points,(21.75±2.07)points vs.(18.58±1.73)points,(27.59±3.25)points vs.(25.74±2.83)points;the femoral tibial angle and the range of motion of the knee joint in the control group and the combined group were increased,and the combined group was greater than the control group:(1.94±0.60)°vs.(3.02±0.67)°;the scores of stability,flexion deformity,muscle strength,range of motion,function,and pain in the control group and the combined group increased,and the combined group was higher than the control group:(8.62±0.86)points vs.(6.89±0.78)points,(7.86±0.96)points vs.(6.27±0.68)points,(7.79±0.62)points vs.(6.95±0.57)points,(14.95±2.60)points vs.(12.48±2.33)points,(17.46±2.21)points vs.(14.59±1.76)points,(24.83±3.25)points vs.(18.59±2.57)points,the difference was statistically significant(P<0.05).During the following up period,there were no significant differences in the incidences of osteofascial compartment syndrome,neurovascular injury,intraarticular adhesion and incision infection between the two groups(P>0.05).Conclusions The operation time of fibular osteotomy combined with arthroscopic debridement of knee joint in patients with knee osteoarthritis was longer,but fibular osteotomy combined with arthroscopic debridement of the knee joint can reduce the valgus of the patient and improve the range of motion of the joint.It could effectively reduce the degree of pain and improve the function of knee joint,and the safety was good,with good therapeutic effect.