关节镜下软骨成形术在胫骨高位截骨术治疗内翻型膝骨关节炎中的应用  

Application of Arthroscopic Chondroplasty in the Treatment of Varus Knee Osteoarthritis by High Tibial Osteotomy

作　　者：佟磊 彭志伟 王云清 朱自强 TONG Lei;PENG Zhi-wei;WANG Yun-qing;ZHU Zi-qiang(Sports Medicine Joint Surgery,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学第二附属医院运动关节外科,江苏徐州221000

出　　处：《骨科》2022年第3期222-228,共7页ORTHOPAEDICS

基　　金：徐州医科大学附属医院科技发展基金项目(XYFM2021030)。

摘　　要：目的探讨关节镜下软骨成形术结合胫骨高位截骨术(high tibial osteotomy,HTO)治疗内翻型膝骨关节炎的临床疗效。方法选取2018年5月至2020年5月我科收治的39例施行HTO的内翻型膝骨关节炎病人,其中在关节镜下对损伤的软骨行成形术的18例纳入观察组,另外21例未在关节镜下对软骨损伤进行处理的病人作为对照组,比较两组病人手术前后的西安大略和麦克马斯特大学(WOMAC)关节炎指数、疼痛视觉模拟量表(VAS)评分、胫骨近端内侧角(medial proximal tibial angle,MPTA)和股胫角(femora tibial angle,FTA),以及两组病人手术前后屈伸角度和屈曲达90°所用时间。结果两组病人手术后WOMAC指数、VAS评分和FTA均较术前显著降低,MPTA较术前明显增大,与术前比较,差异有统计学意义(P<0.05)。另外,两组病人之间术前和术后随访中,MPTA、FTA并无明显差异(P>0.05),而观察组术后WOMAC指数及VAS评分显著低于对照组(P<0.05)。观察组术后末次随访时屈曲和伸直角度明显优于对照组(P<0.05),并且观察组屈曲角度达90°所用时间明显少于对照组(P<0.05)。结论关节镜下软骨成形术结合HTO治疗内翻型膝骨关节炎,疗效肯定,可以显著缓解病人疼痛症状,使病人能够早期高效地开始功能锻炼,获得更好的功能状态。Objective To explore the clinical effect of arthroscopic chondroplasty combined with high tibial osteotomy(HTO)in the treatment of varus knee osteoarthritis.Methods From May 2018 to May 2020,39 cases of knee osteoarthritis with varus deformity who underwent HTO were selected.Eighteen patients who underwent arthroscopic chondroplasty on the injured cartilage were included in the observation group,and the rest 21 patients whose cartilage injury was not given arthroscopy were used as the control group.The Western Ontario and McMaster Universities(WOMAC)osteoarthritis score,visual analogue scale(VAS)score,medial proximal tibial angle(MPTA),femora tibial angle(FTA),the time of flexion and extension angle and flexion reach of 90°were compared between the two groups.Results The WOMAC index,VAS scores and FTA were significantly reduced as compared with those preoperation,MPTA was significantly increased as compared with that preoperation(P<0.05).In addition,there was no significant difference in MPTA and FTA between the two groups during preoperative and postoperative follow⁃up,while the postoperative WOMAC and VAS scores in the observation group were significantly lower than those in the control group(P<0.05).The flexion and extension angles of the last postoperative follow⁃up in the observation group were significantly greater than those in the control group(P<0.05),and the time to reach 90°in the observation group was significantly shorter than in the control group(P<0.05).Conclusion Arthroscopic chondroplasty combined with HTO in the treatment of varus knee osteoarthritis has a positive effect and can significantly alleviate the pain symptoms.The patients can start functional exercise early and efficiently,and obtain a better functional status.

关 键 词：胫骨高位截骨术 软骨成形术 关节镜技术 等离子刀 骨性关节炎 内翻膝 

分 类 号：R687.4[医药卫生—骨科学]