摘要
目的探讨胫骨高位截骨术(HTO)联合关节镜对比单纯关节镜治疗老年退变性膝骨关节炎(KOA)的短期临床疗效(运动及疼痛的改善)。方法对北京市普仁医院从2017年7月至2019年5月内的老年X线Kellgren-Lawrence(K-L)Ⅲ期的KOA患者共41例(42个膝关节)进行回顾分析。选取符合膝骨关节炎诊断标准,且术前磁共振影像证实为内侧KOA,韧带功能完好,膝关节活动度≥100°的60岁以上可连续随访的健康老年患者,除外不符合KOA诊断标准、非骨关节炎、膝关节不稳、术前膝关节活动度<100°或屈曲挛缩>25°、不能耐受麻醉或手术者、严重的髌股关节炎、骨质疏松或外侧间室骨关节炎或外侧半月板切除的60岁以下、失访或非健康患者。根据患者治疗意愿选择治疗方法不同将其分为两组,HTO联合关节镜治疗(联合治疗组)和单纯关节镜治疗组,记录患者基线特征,比较两组术前及术后12个月的膝关节损伤和关节炎评分(KOOS)、活动度和代谢当量。比较联合治疗组术前、术后2周、12个月的胫骨近端内侧角(MPTA)和股胫角(FTA),并记录矫正角度的丢失。使用配对和独立样本t检验、秩和检验和卡方检验进行统计学分析,比较两组患者的术后疼痛缓解时间(生存期),进行Kaplan-Meier曲线分析。结果两组(关节镜组和HTO联合治疗组)患者术后KOOS(疼痛、症状、日常生活能力、运动娱乐、生活质量)评分较术前均有改善(Z=-4.036,t=-12.116,t=-9.392,Z=-3.897,t=-3.623,Z=-4.041,t=-36.102,t=-12.116,Z=-4.133,t=-56.950,均为P<0.001),HTO组术后活动度及代谢当量(METs)较术前明显改善(t=-13.436,Z=-4.116,均为P<0.001),但关节镜组改善不明显,HTO组术后KOOS评分、活动度、代谢当量较关节镜组改善明显(Z=-5.793,t=-27.755,t=-24.366,Z=-5.629,t=-43.958,t=-11.730,Z=-6.099,均为P<0.001),术后2周和12个月FTA及MPTA均较术前改善,术后HTO组可以中、短期(时间>12个月)无痛或微痛生存,明�
Objective To investigate the short-term clinical efficacy of high tibial osteotomy(HTO)combined with arthroscopy versus arthroscopy alone in the treatment of senile degenerative knee osteoarthritis(KOA)(improvement of sport and pain).Methods A total of 41 elderly patients(42 knees)with Kellgren-Lawrence(K-L)stageⅢKOA in Beijing Puren Hospital from July 2017 to May 2019 were retrospectively analyzed.The inclusion criteria:patients met the diagnostic criteria of knee osteoarthritis and were confirmed as medial KOA by preoperative MRI with intact ligament function;healthy elderly patients over 60 years;the range of motion of knee above 100°;the patients could be followed up continuously.The exclusion criteria:the patients who did not meet the diagnostic criteria for KOA;age under 60 years;severe patellofemoral arthritis or osteoporosis or lateral compartment osteoarthritis;lateral meniscectomy;not degenerative osteoarthritic;unstable knees;preoperative range of motion of knee under 100°or flexion contracture>25°;the patients could not tolerate anesthesia or surgery;the patients lost follow-up,or were not healthy.The enrolled patients were divided into two groups according to their willingness for treatment methods:the HTO combined with arthroscopy group(the combined treatment group)and the arthroscopy group.The baseline characteristics of the patients were recorded.Knee injury&osteoarthritis score(KOOS),range of motion(ROM)and metabolic equivalents(METs)were compared between the two groups before the operation and 12 months after the operation.The proximal medial tibial angle(MPTA)and femorotibial angle(FTA)of the combined treatment group were compared before the operation,two weeks and 12 months after the operation,and the loss of correction angle was recorded.Paired and independent sample t test,rank sum test and chi square test were used for statistical analysis.Kaplan-Meier curve analysis was performed.Results The postoperative KOOS(pain,symptoms,activities of daily living,sports and recreation,quality of l
作者
张海东
滕涛
陈阳
刘俊英
郑宏伟
英吉林
武志刚
何保玉
Zhang Haidong;Teng Tao;Chen Yang;Liu Junying;Zheng Hongwei;Ying Jilin;Wu Zhigang;He Baoyu(Department of Orthopedic,Beijingshi Puren Hospital,Beijing 100062,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2022年第6期705-714,共10页
Chinese Journal of Joint Surgery(Electronic Edition)
