两种截骨术式治疗膝关节内侧间室骨关节炎的疗效比较  

Comparison of two osteotomies in the treatment of medial compartment osteoarthritis

作　　者：许康永 童也 赵鹏[1] 周烨[1] 石少辉[2] XU Kangyong;TONG Ye;ZHAO Peng;ZHOU Ye;SHI Shaohui(Department of Orthopedics,Suzhou Hospital Affiliated to Anhui Medical University,Suzhou Anhui,234000,P.R.China;Department of Orthopedics,Aviation General Hospital of China Medical University,Beijing,100012,P.R.China)

机构地区：[1]安徽医科大学附属宿州医院骨科,安徽宿州234000 [2]中国医科大学航空总医院骨科,北京100012

出　　处：《中国修复重建外科杂志》2021年第11期1440-1448,共9页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽医科大学校科研基金(2020xkj262);北京市朝阳区科技计划项目(CYSF1829)。

摘　　要：目的比较改良胫骨结节下单平面胫骨高位截骨术(modified distal tibial tubercle-high tibial osteotomy,DTT-HTO)和内侧开放楔形HTO(open-wedge HTO,OWHTO)治疗膝关节内侧间室骨关节炎的疗效差异。方法回顾分析2016年1月—2019年1月采用HTO治疗的80例膝关节内侧间室骨关节炎患者临床资料,其中40例采用DTT-HTO(DTT-HTO组)、40例采用OWHTO(OWHTO组)。两组患者性别、年龄、身体质量指数、侧别、病程、骨关节炎Kellgren-Lawrence分级,以及术前膝关节学会评分系统(KSS)评分、美国特种外科医院(HSS)评分、膝关节疼痛视觉模拟评分(VAS)、髋-膝-踝角(hip-knee-ankle angle,HKA)、胫骨平台后倾角(posterior tibial slope,PTS)、下肢负重力线比率(weight-bearing line ratio,WBL)、Blackburne-Peel指数(Blackburne-Peel index,BPI)、Caton-Deschamps指数(Caton-Deschamps index,CDI)、Insall-Salvati指数(InsallSalvati index,ISI)比较,差异均无统计学意义(P>0.05)。记录两组手术时间、切口长度、出血量、住院时间以及并发症发生情况;采用KSS评分、HSS评分、VAS评分综合评价疗效;采用自制调查问卷评价患者膝关节低冲击运动能力恢复情况。X线片复查截骨愈合情况,测量HKA、PTS、WBL以及髌骨高度相关指数(BPI、CDI、ISI)。结果两组手术均顺利完成,OWHTO组手术时间长于DTT-HTO组(P<0.05),切口长度、出血量、住院时间组间差异均无统计学意义(P>0.05)。术后两组切口均Ⅰ期愈合。OWHTO组发生外侧合页骨折2例,DTT-HTO组发生外侧合页骨折1例、平台骨折2例;无其他并发症发生。两组患者均获随访,随访时间2~4年,平均2.8年。两组术后HSS评分、KSS评分、VAS评分均较术前改善,术后随时间延长均进一步改善,组内各时间点间差异均有统计学意义(P<0.05)。DTT-HTO组术后3个月HSS评分、KSS评分、VAS评分优于OWHTO组(P<0.05),术后6个月及1、2年时组间差异均无统计学意义(P>0.05)。术后1年,OWHTO组膝�Objective To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy(DTT-HTO) and open-wedge HTO(OWHTO) in the treatment of medial compartment osteoarthritis. Methods A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO(DTT-HTO group) and 40 patients treated with OWHTO(OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score(KSS), Hospital for Special Surgery(HSS) score, knee joint visual analogue scale(VAS) score, hip-knee-ankle angle(HKA), posterior tibial slope(PTS), weight-bearing line ratio(WBL), Blackburne-Peel index(BPI), Caton-Deschamps index(CDI), and InsallSalvati index(ISI) between the two groups(P>0.05). The operation time, incision length, bleeding volume, hospital stay,and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness.A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes(BPI, CDI, ISI).Results All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group(P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups(P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared wit

关 键 词：膝关节 内侧间室 骨关节炎 内侧开放楔形胫骨高位截骨术 改良胫骨结节下单平面胫骨高位截骨术 

分 类 号：R687.4[医药卫生—骨科学]