膝关节镜结合胫骨内侧开放楔形高位截骨治疗内翻性膝内侧间室骨关节炎  

Knee arthroscopic surgery combined with open wedge high tibial osteotomy in the treatment of varus osteoarthritis of knee medial compartment

作　　者：李宗原[1] 石波[1] 王陶[1] 唐诗添[1] 康斌[1] 许瀚 谢明锐 弋卓君 LI Zong-yuan;SHI Bo;WANG Tao;TANG Shi-tian;KANG Bin;XU Han;XIE Ming-rui;YI Zhuo-jun(Dept of Orthopaedics,the Central Hospital of Mianyang City,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市中心医院骨科,四川绵阳621000

出　　处：《临床骨科杂志》2022年第6期817-821,共5页Journal of Clinical Orthopaedics

基　　金：四川省医学会骨科(尚安通)专项科研课题(编号:2019AST25)。

摘　　要：目的探讨膝关节镜结合胫骨内侧开放楔形高位截骨(OWHTO)治疗内翻性膝内侧间室骨关节炎的疗效。方法采用膝关节镜结合OWHTO治疗56例内翻性膝内侧间室骨关节炎患者。记录截骨、植骨愈合情况及并发症发生情况、膝关节活动度、疼痛VAS评分、WOMAC评分、髋-膝-踝角(HKA)、胫骨近端内侧角(MPTA)、K-L膝骨关节炎分级情况。采用HSS评分评价膝关节功能优良率。结果患者均获得随访,时间42~48(44.63±2.37)个月。截骨、植骨处均愈合,时间3~7(3.37±0.86)个月。无切口深部感染、皮肤坏死、钢板断裂等并发症发生。末次随访时,患者均可完全负重行走,膝关节活动度:伸直-4°~4°(0.46°±1.45°),屈曲95°~143°(126.96°±10.90°);疼痛VAS评分、HSS评分、WOMAC评分、HKA、MPTA明显优于术前,差异均有统计学意义(P<0.05);5膝K-L膝骨关节炎分级降低1级,其余膝分级无变化;采用HSS评分评价膝关节功能优良率为91.23%(52/57)。结论采用膝关节镜结合OWHTO治疗内翻性膝内侧间室骨关节炎,既能保证软骨的修复,又能快速并持久地改善患者症状,临床疗效肯定。Objective To investigate the efficacy of knee arthroscopic surgery combined with open wedge high tibial osteotomy(OWHTO)in the treatment of varus osteoarthritis of knee medial compartment.Methods The 56 patients with varus osteoarthritis of knee medial compartment were treated by knee arthroscopy combined with OWHTO.The following data were recorded,including osteotomy,fusion condition of bone graft,complications,range of motion(ROM)of knee join,pain VAS,WOMAC score,hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA)and K-L grading of knee osteoarthritis.The excellent-good rate of knee function was evaluated by HSS scoring.Results All patients were followed up for 42~48(44.63±2.37)months.The fusion time of the sites of osteotomy and bone graft within 3~7(3.37±0.86)months.No complications such as deep infection of the incision,skin necrosis and plate fracture occurred.At the last follow-up,all patients could walk with full weight-bearing,and the knee ROM was-4°~4°(0.46°±1.45°)for extension,and 95°~143°(126.96°±10.90°)for flexion.Pain VAS,HSS score,WOMAC score,HKA and MPTA were significantly better than those before surgery,and the differences were statistically significant(P<0.05).K-L knee osteoarthritis grade of 5 knees were decreased by 1 grade,and other knees′grades had no changes;the excellent-good rate of knee function evaluated by HSS scoring was 91.23%(52/57).Conclusions The application of knee arthroscopy combined with OWHTO in the treatment of varus osteoarthritis of knee medial compartment can not only ensure the repair of cartilage,but also improve the symptoms of patients fastly and persistently,with positive clinical efficacy.

关 键 词：胫骨高位截骨术 开放楔形 关节镜检查 膝骨关节炎 

分 类 号：R684.3[医药卫生—骨科学] R687.4[医药卫生—外科学] R446.1[医药卫生—临床医学]