胫骨内侧开放性高位楔形截骨术治疗KOA的应用研究

Study on the application of open high wedge osteotomy of the medial tibia in the treatment of KOA

目的探讨不同目标WBL设定下MOWHTO治疗KOA的疗效差异。方法将2019年6月-2021年6月于本科室因KOA拟行MOWHTO的48例患者纳入研究,根据术前JSW分为2组,JSW>3mm组28例和JSW≤3mm组20例。术前将2组患者随机分配为WBL调整至50%~60%组和60%~65%组。比较4组患者术前及末次随访VAS评分、WOMAC评分、膝关节MRI检查、术中及术后12月关节镜下探查软骨情况。结果所有患者均随访至少12个月(平均14.6个月),末次随访膝关节MRI软骨再生分级、软骨再生情况、VAS评分、WOMAC评分均较术前有显著差异(P<0.05)。JSW>3mm者中WBL调整至50%~60%组上述指标更优。JSW≤3mm者中WBL调整至60%~65%组上述指标更优。结论采用MOWHTO治疗KOA可获得良好的早期临床疗效,但JSW>3mm者将下肢力线调整至50%~60%可获得更好的软骨再生和患者满意度,而JSW≤3mm者增加矫正力线可获得更好的临床收益。

Objective To explore curative effect differences of MOWHTO in the treatment of KOA under different target WBL settings.Methods Forty-eight patients who were proposed to undergo MOWHTO for KOA in our department from June 2019 to June 2021,were included in the study and divided them into two groups according to preoperative JSW,28 patients were in the JSW>3 mm group and 20 patients were in the JSW≤3 mm group.Before the operation,patients in both groups were randomly assigned to the WBL-adjusted to 50%~60%group and the 60%~65%group.VAS scores,WOMAC scores,knee joint MRI examinations,intraoperative and 12 months postoperative arthroscopic exploration of cartilage in 4 groups were compared before and at the last follow-up.Results All patients were followed up for at least 12 months(average 14.6 months).There was significant difference in cartilage regeneration grade,cartilage regeneration,VAS score,and WOMAC score on MRI of the knee at the last follow-up which compared with those before the surgery(P<0.05).The above indexes were better in the group of WBL-adjusted 60%~65%,as well in the group of JSW≤3mm.Conclusions Good early clinical effects can be obtained by using MOWHTO in the treatment of KOA,but patients with JSW>3 mm adjusted lower limb line of force to 50%~60%can obtain better cartilage regeneration and satisfaction,while patients with JSW≤3 mm increased corrective line of force can obtain better clinical benefits.