中度与重度内侧单间室骨关节炎内侧开放楔形胫骨高位截骨术的疗效比较  

Comparison of the effect of medial open wedge high tibial osteotomy for moderate and severe knee osteoarthritis

作　　者：任富继 黄竞敏[1] 陈啸[1] 吴疆[1] 赵谦[1] 骆巍 郑慧锋 Ren Fuji;Huang Jingmin;Chen Xiao;Wu Jiang;Zhao Qian;Luo Wei;Zheng Huifeng(Department of Sports Injuries and Arthroscopy,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院运动损伤与关节镜科,天津300211

出　　处：《中华骨科杂志》2022年第9期545-554,共10页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康科技项目(ZC20086)。

摘　　要：目的探讨中度与重度内侧单间室膝关节骨关节炎内侧开放楔形胫骨高位截骨术的疗效。方法回顾性分析2017年1月至2019年1月行内侧开放楔形胫骨高位截骨术且随访2年以上的60例膝关节骨关节炎患者。重度内侧单间室骨关节炎28例,男11例、女17例,年龄(56.36±5.06)岁;中度内侧单间室骨关节炎32例,男12例、女20例,年龄(54.16±6.3)岁。术前和术后2年通过影像学检查评估Kellgren-Lawrence分级、髋-膝-踝角、负重力线比率、关节线汇聚角、内侧关节间隙宽度、胫骨平台后倾角、内侧半月板外凸和内侧半月板外凸比;于关节镜下评估股骨内髁和内侧胫骨平台软骨的国际软骨修复协会(International Cartilage Repair Society,ICRS)分级;以西安大略和麦克马斯特大学(Western Ontario and McMaster University,WOMAC)骨关节炎指数、视觉模拟评分(visual analogue scale,VAS)、内侧副韧带假性松弛程度评价临床疗效。采用二分类变量logistic回归分析,筛选内侧副韧带假性松弛的预测因子。结果术后两组Kellgren-Lawrence分级、髋-膝-踝角、负重力线比率、内侧关节间隙宽度均改善,组间差异无统计学意义(P>0.05)。关节线汇聚角术后改善、内侧半月板外凸和内侧半月板外凸比无改善,手术前后重度组均大于中度组(P<0.05)。股骨内髁软骨:重度组由ICRS分级3级2例、4级26例改善至2级11例、3级12例、4级5例,中度组由2级12例、3级18例、4级2例改善至2级30例、3级2例;胫骨平台软骨:重度组由3级2例、4级26例改善至2级17例、3级8例、4级3例,中度组由2级11例、3级18例、4级3例改善至2级27例、3级5例。重度组术后WOMAC评分由(50.71±8.07)分降低至(3.86±1.84)分、中度组由(44.09±6.63)分降低至(3.34±2.24)分,重度组VAS评分由(7.14±1.21)分降低至(3.34±2.24)分、中度组由(6.38±1.24)分降低至(0.44±0.62)分,术后组间差异无统计学意义(P>0.05)。重度组0°位和30°Objective To investigate the effect of medial open wedge high tibial osteotomy(HTO)on moderate and severe medial compartmental knee osteoarthritis.Methods This study retrospectively reviewed patients treated with medial open wedge HTO between January 2017 and January 2019.All cases were followed up for more than 2 years.There were 28 patients with severe osteoarthritis,including 11 males and 17 females,aged 56.36±5.06 years.There were 32 patients with moderate osteoarthritis,including 12 males and 20 females,aged 54.16±6.3 years.Kellgren-Lawrence(K-L)grading,hip-knee-ankle angle(HKA),weight bearing line(WBL)ratio,joint line convergence angle(JLCA),medial joint space(MJS),posterior tibial slope(PTS),medial meniscus extrusion(MME)and medial meniscus extrusion ratio(MMER)were evaluated on radiographs before and 2 years after surgery.The International Cartilage Repair Society(ICRS)of the cartilage of medial femoral condyle(MFC)and medial tibial condyle(MTC)were evaluated under arthroscopy.The clinical outcomes were assessed by the Western Ontario and McMaster University(WOMAC)score,visual analogue scale(VAS)and the degree of medial collateral ligament(MCL)pseudo-relaxation.Predictors of MCL pseudo-relaxation were screened by binary logistic regression analysis.Results K-L grading,HKA,WBL ratio and MJS improved in both groups after surgery,with no statistical significance between groups(P>0.05).The postoperative JLCA was improved,whereas MME and MMER were not.And the severe group was higher than the moderate group before and after surgery(P<0.05).Cartilage of MFC:in the severe group,2 cases of ICRS 3 grade,26 of 4 grade improved to 11 of 2 grade,12 of 3 grade,5 of 4 grade;in the moderate group,12 cases of ICRS 2 grade,18 of 3 grade,2 of 4 grade improved to 30 of 2 grade,2 of 3 grade.Cartilage of MTC:in the severe group,2 cases of ICRS 3 grade,26 of 4 grade improved to 17 of 2 grade,8 of 3 grade,3 of 4 grade;in the moderate group,11 of 2 grade,8 of 3 grade,3 of 4 grade improved to 27 of 2 grade,5 of 3 grade.The posto

关 键 词：骨关节炎 膝 截骨术 内侧副韧带 膝 

分 类 号：R687.3[医药卫生—骨科学]