摘要
目的对比腓骨近端截骨术与关节镜清理术治疗内侧间室性膝关节骨关节炎(KOA)的临床疗效。方法回顾性收集2015年5月至2015年9月襄汾温泉医院收治的符合纳入排除标准的KOA患者55例,根据术式不同分为腓骨近端截骨组(n=34)与关节镜清理组(n=21),分别于术前、术后7 d、1个月、6个月、12个月随访,并比较患者手术前后美国特种外科医院(HSS)膝关节评分、疼痛视觉模拟评分(VAS)及膝关节协会评分(KSS),腓骨截骨组手术前后行下肢负重X线片,观察内侧间隙及下肢力线变化情况。结果 55例患者均获得完整随访,随访时间12~14个月,平均(13.0±0.7)个月。术前两组患者一般情况及VAS、KSS临床评分、KSS功能评分比较,差异均无统计学意义。HSS评分比较,腓骨截骨组低于关节镜清理组,差异有统计学意义(F=2.135,P<0.05)。术后各时间点腓骨截骨组VAS、HSS评分均优于关节镜清理组,差异均有统计学意义(F=7.387,F=1.533,P<0.05),随着时间延长,两组患者VAS、HSS评分均逐渐改善,差异均有统计学意义(F=282.434,F=281.892,P<0.05),组间KSS临床评分、KSS功能评分比较差异无统计学意义,但两组术后各时间点KSS临床评分及KSS功能评分均逐渐改善,差异均有统计学意义(F=56.991,F=78.360,P<0.05)。截骨组患者手术前后下肢负重X线片显示内侧间隙均有不同程度增宽。腓骨截骨组患者有3例出现术后足背外侧麻木,拇趾背伸无力,5例患者术后自感下肢负重能力下降。关节镜清理组患者有5例术后1个月出现关节腔积液。结论腓骨近端截骨治疗内侧间室疼痛KOA明显优于关节镜清理术,术后可有效减轻疼痛,改善膝关节功能,手术操作简易、创伤小、风险低,作为治疗KOA的一种方法,值得临床广泛推广应用。
Objective To compare of clinical efficacy of proximal fibular osteotomy and arthroscopic debridement in the treatment of medial compartment of the knee osteoarthritis (KOA).Methods Fifity-five KOA patients met the inclusion criteria were included from May 2015 to Sep 2015 in Xiangfen hotspring hospital, they were divided into proximal fibular osteotomy group (n=34) and arthroscopic debridement group (n=21), and the hospital for special surgery (HSS) knee score, visual analogue scale (VAS) and Knee Society score (KSS) were respectively followed-up before surgery and at 7 d, 1 months, 6 months, 12 months postoperative. Comparison were done between two groups, the X-ray of lower extremity were done before and after surgery to observe the change of medial compartment space and axial alignment. Results All patients were followed up for 12-14 months (13.0±0.7 months). There were no difference between two groups on VAS, clinical KSS score, KSS function score preoperatively (P>0.05), but the HSS score of fibular osteotomy group was lower than that of the arthroscopic group, with statisticalsignificance (F=2.135, P<0.05). After treatment, the VAS and HSS scores in fibular osteotomy group were higher than ttat in arthroscopic group, with statistical significance (F=7.387, F=1.533, P<0.05),over time, VAS and HSS score gradually improved, with statistical significance (F=282.434, F=281.892, P<0.05), while no significant differences were observed in clinical and functional KSS score. But the KSS score of both groups were significantly increased over time(F=56.991, F=78.360, P<0.05). Postoperative X-ray showed the medial compartment space of the fibular osteotomy group were larger in different extend than preoperatively. Postoperative lateral dorsal foot numbness and hallux dorsiflexion weakness occurred in 3 cases of the fibular osteotomy group, 5 patients feel less control of their weight capacity. Five cases in the arthroscopic debridement group had intra- articular effusion at 1 months after operation. Conclusion Proximal
作者
姚国军
尹淑梅
赵庆海
梁朝阳
宋洁富
Yao Guojun;Yin Shumei;Zhao qinghai;Liang Chaoyang;Song jiefu(Department of orthopedics, Xiangfen hotspring hospital, 041500 linfen, China;Department of orthopedics Shanxi People's Hospital, 030001 Taiyuan, China)
出处
《中华老年骨科与康复电子杂志》
2017年第2期103-108,共6页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
山西省自然科学基金(2015011121)
关键词
膝关节
骨关节炎
截骨术
关节镜清理
Knee joint
Osteoarthritis
Osteotomy
Arthroscopic debridement
