腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎  

PROXIMAL FIBUL AR OSTEOTOMY C OMBINED WITH ARTHROSC OPIC DEBRIDEMENT FOR TREATING MEDIAL KNEE OSTEOARTHRITIS WITH VARUS

作　　者：郝亮[1] 简蔚泓[2] 杨锋 刘春龙[1] 唐强[1] 

机构地区：[1]南昌大学第二附属医院骨科,南昌330006 [2]南昌大学第三附属医院骨科 [3]九江市第六人民医院骨科

出　　处：《中国修复重建外科杂志》2016年第11期1366-1369,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：江西省卫生和计划生育委员会科技计划项目(20165214)~~

摘　　要：目的探讨腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎(osteoarthritis,OA)临床疗效。方法 2013年12月-2015年6月,收治61例伴内翻畸形的膝关节OA患者,其中32例采用单纯关节镜下膝关节清理术(A组),29例采用腓骨近端截骨联合膝关节镜清理术(B组)。患者年龄、性别、侧别、病程、OA分期、术前疼痛视觉模拟评分(VAS)及膝关节学会评分系统(KSS)比较,差异均无统计学意义(P>0.05),具有可比性。术后1周、3个月、12个月采用VAS评分及KSS评分分别评价患膝疼痛及患肢功能恢复情况。结果两组患者均获随访12个月。患者切口均Ⅰ期愈合;A、B组并发症发生率分别为0、3.4%,差异无统计学意义(χ2=0.723,P=0.432)。两组术后1周、3个月、12个月VAS评分均明显低于术前(P<0.05);A组术后1周VAS评分显著低于B组,但3、12个月时却显著高于B组,比较差异有统计学意义(P<0.05)。术后两组患者膝关节功能均显著恢复,术后1周、3个月、12个月KSS评分均明显优于术前(P<0.05);A组术后1周KSS评分与B组比较差异无统计学意义(P>0.05),但术后3、12个月评分显著低于B组(P<0.05)。结论腓骨近端截骨联合膝关节镜清理术能同时处理膝关节力线不良及关节内病变,是治疗伴内翻畸形的膝关节OA的一种安全、有效方法。ObjectiveTo evaluate the effectiveness of proximal fibular osteotomy combined with arthroscopic debridement in the treatment of medial knee osteoarthritis with varus. MethodsBetween December 2013 and June 2015, 61 patients with medial knee osteoarthritis with varus were treated by arthroscopic debridment in 32 cases （group A） and by proximal fibular osteotomy combined with arthroscopic debridement in 29 cases （group B）. No significant difference was found in gender, age, side, disease duration, OA stage, visual analogue scale （VAS） score, and knee society score （KSS） between 2 groups （P 〉 0.05）. The clinical outcome was evaluated by VAS score and KSS score at 1 week, 3 months, and 12 months after operation. ResultsThe patients in 2 groups were followed up 12 months. All incisions healed by first intention. There was no significant difference in complication incidence between groups A and B （0 vs. 3.4%; χ^2=0.723, P=0.432）. The VAS scores were significantly decreased at 1 week, 3 months, and 12 months after operation when compared with preoperative score in 2 groups （P 〈 0.05）. The VAS score of group A was significantly lower than that of group B at 1 week after operation （P 〈 0.05）, but the VAS score of group A was significantly higher than that of group B at 3 months, and 12 months after operation （P 〈 0.05）. The knee function was obviously improved in 2 groups, and the KSS scores at 1 week, 3 months and 12 months after operation were significantly better than preoperative score （P 〈 0.05）. The KSS score of group A was significantly lower than that of group B at 3 months, and 12 months after operation （P 〈 0.05）. ConclusionProximal fibular osteotomy combined with arthroscopic debridement can treat knee malalignment and disease in knee, it is an effective and safe method to treat the medial knee osteoarthritis with varus.

关 键 词：膝关节 骨关节炎 内翻畸形 关节镜清理术 腓骨近端截骨术 

分 类 号：R687.4[医药卫生—骨科学]