OWHTO联合半月板中央化与膝单髁置换术治疗内侧膝关节骨关节炎的临床效果分析

Clinical Effect Analysis of OWHTO Combined with Meniscus Centralization and Unicompartmental Knee Arthroplasty in the Treatment of Medial Knee Osteoarthritis

目的:探讨开放楔形胫骨高位截骨(open wedge high tibial osteotomy,OWHTO)联合半月板中央化与膝单髁置换术(unicompartmental knee arthroplasty,UKA)治疗内侧膝关节骨关节炎的临床效果。方法:回顾性分析滨州医学院附属医院2019年1月—2021年12月手术治疗的82例内侧膝关节骨关节炎患者,按照手术方法不同分为观察组(n=40,予以OWHTO联合半月板中央化)与对照组(n=42,予以UKA)。比较两组手术相关指标,术前及术后1个月、1年、2年膝关节屈曲度、疼痛评分[视觉模拟评分法(VAS)]及功能[美国膝关节协会(AKS)评分、Lysholm膝关节评分],以及并发症发生情况。结果:观察组手术时间长于对照组,差异有统计学意义(P<0.05);两组术中出血量、术后引流量和住院时间比较,差异均无统计学意义(P>0.05)。术后1个月、1年、2年,两组VAS评分、AKS评分、Lysholm膝关节评分、膝关节屈曲度均较术前明显改善,差异均有统计学意义(P<0.05)。术后1个月,观察组膝关节屈曲度大于对照组,Lysholm膝关节评分、VAS评分均高于对照组(P<0.05)。术后2年,观察组VAS评分低于对照组,AKS评分和Lysholm膝关节评分均高于对照组(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:相较于UKA,采用OWHTO联合半月板中央化治疗内侧膝关节骨关节炎,虽其手术时间更长,但仍保留了患者本体感觉及结构,可有效改善膝关节活动度、降低疼痛程度、促进膝关节功能恢复,更符合保膝理念。

Objective:To investigate the clinical efficacy of open wedge high tibial osteotomy(OWHTO)combined with meniscus centralization and unicompartmental knee arthroplasty(UKA)in the treatment of patients with medial knee osteoarthritis.Method:A total of 82 patients with medial knee osteoarthritis treated by surgery in Binzhou Medical University Hospital from January 2019 to December 2021 were retrospectively analyzed,and they were divided into observation group(n=40,OWHTO combined with meniscus centralization)and control group(n=42,UKA)according to different surgical methods.Surgery-related indicators,knee flexion,pain score[visual analogue scale(VAS)],function[American knee association(AKS)score,Lysholm knee score]1 month,1 year and 2 years after surgery,and complications were compared between the two groups.Result:The operation time in the observation group was longer than that in the control group,the difference was statistically significant(P<0.05).There were no significant differences in intraoperative blood loss,postoperative drainage volume and hospital stay between the two groups(P>0.05).1 month,1 year and 2 years after surgery,VAS score,AKS score,Lysholm knee score and knee flexion of the two groups were significantly improved compared with those before operation,the differences were statistically significant(P<0.05).1 month after surgery,knee flexion of observation group was higher than that of control group,Lysholm knee score and VAS score were higher than those of control group(P<0.05).2 years after surgery,VAS score of observation group was lower than that of control group,AKS score and Lysholm knee score were higher than those of control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Compared with UKA,OWHTO combined with meniscus centralization in the treatment of medial knee osteoarthritis,although the operation time is longer,the patients'proprioception and structure are still retained,which can effectively improve the range of motion of knee,reduce the degree of pain,and promote the recovery of knee function,which is more in line with the concept of knee preservation.