胫骨高位外翻截骨、关节镜清理联合富血小板血浆治疗膝关节骨关节炎

Clinical therapeutic effects of opening wedge high tibial valgus osteotomy and arthroscopic debridement combined with platelet-rich plasma intra-articular injection on knee osteoarthritis

目的探讨胫骨高位外翻截骨、关节镜清理联合富血小板血浆关节腔注射治疗膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻的可行性及疗效。方法对2011年4月至2013年7月在内蒙古自治区国际蒙医医院骨科就诊的膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻患者26例(31膝),其中男4例,女22例,行胫骨高位外翻截骨植骨术矫正膝内翻畸形,辅以关节镜关节清理术,术后自体富血小板血浆关节腔注射。观察截骨部位愈合时间,评估疗效优良率,记录治疗后72 h、6周、12周、24周VAS评分、KSS评分、HSS评分及FTA变化,采用重复测量方差分析进行分析;术后12周、24周MRICRS分级变化情况用pearson卡方检验。术后随访2~5年,平均4.7年。结果术后截骨部位临床愈合时间为(12.76±0.98)周,无感染及不愈合。疗效优26膝(83.87%),良4膝(12.90%),可1膝(3.33%),差0膝,优良率为96.77%。治疗前VAS评分(6.8±0.9)分,治疗后72 h、6周、12周、24周分别为(1.0±0.3)分、(0.4±0.02)分、(0.2±0.05)分、(0.2±0.01)分,与治疗前比较差异有统计学意义(P<0.05);HSS评分治疗前(43.1±3.4)分,治疗后分别为(79.9±2.4)分、(89.6±1.8)分、(93.1±2.2)分、(93.2±2.1)分,与术前比较差异有统计学意义(P<0.05);KSS临床评分和KSS功能评分治疗前分别为(36.8±4.1)分、(33.7±1.9)分,治疗后分别为(64.7±5.4)分、(72.4±4.4)分、(85.2±7.1)分、(88.7±5.5)分和(67.3±6.6)分、(75.2±5.3)分、(85.5±6.9)分、(89.1±6.1)分,与治疗前比较差异有统计学意义(P<0.05);FTA治疗前为184.9°±4.6°,术后分别为171.6°±3.1°、171.4°±2.7°、171.4°±2.3°、171.1°±1.9°,与治疗前比较差异有统计学意义(P<0.01)。治疗前关节软骨ICRS分级Ⅱ级19膝(59.37%)、Ⅲ级12膝(40.63%)。治疗12周后Ⅰ级25膝(80.65%)、Ⅱ级6膝(19.35%),治疗24周后Ⅰ级29膝(93.55%)、Ⅱ级2膝(6.45%),软骨修复效果显著(P<0.01)。结论胫骨高位外翻截骨、关节镜清理联合富血小板血浆关节腔注射疗法是治疗膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻安全有效的方法。

Objective To discuss the efficiency and safety of opening wedge high tibial osteotomy(OWHTO) and arthroscopic debridement(AD) combined with platelet-rich plasma(PRP) intra-articular injection in patients with KOA and mild-to-moderate varus deformity. Methods 26 patients(31 knee; 4 males, 22 females) with KOA and mild-to-moderate varus deformity in Inner Mongolia International Mongolian Hospital between April 2011 and July 2013 receiving OWHTO, AD and PRP intra-articular injection were analyzed. The healing time of the osteotomy site was observed, the effective rate was evaluated, the changes of VAS, KSS, HSS and FTA score at 72 h, 6 weeks, 12 weeks, 24 weeks after treatment and the changes of ICRS at 12 weeks, 24 weeks after treatment were recorded by analysis of variance of repeated measurement and Pearson chi square test. Results The postoperative clinical bone healing time was(12.76±0.98) weeks, there was no infection and nonunion. The excellent and good rate was 96.77%(excellent 83.87%, good 12.9%). The VAS at different time point after treatment were significant decreased(1.0±0.3, 0.4±0.02, 0.2±0.05, 0.2±0.01 vs 6.8±0.9; P<0.05); The KSS at different time point after treatment were significant improved(79.9±2.4, 89.6±1.8, 93.1±2.2, 93.2±2.1 vs. 43.1±3.4; P<0.05); The clinical HSS and function HSS at different time point after treatment were also significant improved(64.7±5.4, 72.4±4.4, 85.2±7.1, 88.7±5.5 vs. 36.8±4.1; 67.3±6.6, 75.2±5.3, 85.5±6.9, 89.1±6.1 vs. 33.7±1.9, P<0.05); The FTA at different time point after treatment also had significant difference(171.6°±3.1°, 171.4°±2.7°, 171.4°±2.3°, 171.1°±1.9° vs. 184.9°±4.6°, P<0.01). The repair effect of articular cartilage after treatment were significant increased(before treatment ICRSⅡ19 knees 59.37%, ICRS Ⅲ 12 knees 40.63%; 12 weeks after treatment ICRSⅠ25 knees 80.65%, ICRSⅡ 6 knees 19.35%; 24 weeks after treatment ICRSⅠ29 knees 93.55%, ICRSⅡ 2 knees 6.45%, P<0.01). Conclusion OWHTO-AD combined with PRP intra-articular injection is efficient and safe for KOA with mild-to-moderate varus deformity.