胫骨高位截骨术联合关节镜下骨髓刺激治疗膝内侧单间室骨关节炎的临床效果  

Effect of high tibial osteotomy combined with arthroscopic bone marrow stimulation technique to treat single compartment osteoarthritis of medial knee joint

作　　者：郭旗[1,2] 张传林 黄久勤[1] 刘如月[1] 韩枫[1] 周建国[1] 张舜[1] 卢兆安[1] 郑稼[2] GUO Qi;ZHANG Chuan-lin;HUANG Jiu-qin;LIU Ru-yue;HAN Feng;ZHOU Jian-guo;ZHANG Shun;LU Zhao-an;ZHENG Jia(Department of Orthopedics and Joint Surgery,Shangqiu First People’s Hospital,Shangqiu,Henan 476100,China;People’s Hospital of Zhengzhou University,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]商丘市第一人民医院骨一科关节外科,河南商丘476100 [2]郑州大学人民医院河南省人民医院关节外科,郑州450003

出　　处：《医药论坛杂志》2023年第1期43-46,50,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(2018020950)。

摘　　要：目的 观察联合应用胫骨高位截骨手术和膝关节镜下的骨髓刺激手术处理膝内侧单间室骨关节炎的临床效果。方法 从2018年1月至2019年4月期间,选择21例在商丘市第一人民医院治疗的膝内侧单间室病变的骨关节炎患者,均采用了联合应用胫骨高位截骨术和关节镜下手术治疗,采用疼痛视觉模拟评分(visual analogue scale,VAS),Lysholm评分量表,美国膝关节协会评分(American knee society knee Score,AKS)进行评价,通过影像学进行评价,在负重位下肢全长X线上观察胫骨近端内侧角(medial proximal tibial angle,MPTA),在膝关节磁共振上对软骨进行Noyes评分。观察术后并发症发生情况。结果 为期2年的随访,21例患者术后均未出现并发症。术后的疼痛VAS评分较术前明显降低,差异存在统计学意义(P<0.05)。Lysholm评分、AKS评分,术前和术后比较,评分改善,具有统计学意义(P<0.05)。MPTA角,术前和术后2周对比,角度明显改善,存在统计学意义(P<0.05)。Noyes评分分级,术前和术后半年比较,分级下降,存在统计学意义(P<0.05)。结论 联合应用胫骨高位截骨手术和关节镜下骨髓刺激手术治疗,可以改善骨关节炎患者的关节力线,改善关节功能,为内侧软骨再生创造良好的环境,能较快缓解术前疼痛,并能保持治疗效果。Objective To observe the effect of high tibial osteotomy combined with arthroscopic bone marrow stimulation technique to treat the single compartment osteoarthritis of the medial knee joint.Methods Totally 21 patients with knee osteoarthritis admitted to the First People’s Hospital of Shangqiu City from January 2018 to April 2019 were selected.All patients underwent high tibial osteotomy combined with arthroscopic bone marrow stimulation therapy, visual analogue scale(VAS) for pain, Lysholm scoring scale and American Knee Society Knee Score(AKS) were evaluated. Evaluation was performed by imaging. The medial proximal tibial Angle(MPTA) was observed on the full-length X-ray line of the lower extremity in the weight-bearing position, and the cartilage was evaluated by Noyes score on the MRI of the knee joint.The incidence of postoperative complications was observed.Results The 21 patients were followed up for 2 years, without any complications.VAS scores showed that the pain scores after surgery were significantly lower than those of before surgery, and the difference was statistically significant(P<0.05).Lysholm score and AKS score were significantly different before and half a year after surgery, and the scores were significantly improved, the difference were statistically significant(P<0.05).The MPTA angles were significant difference before surgery and 2 weeks after surgery, the angles were significantly improved and the difference was statistically significant(P<0.05).The Noyes score decreased before surgery and half a year after surgery, and the difference was statistically significant(P<0.05).Conclusion High tibial osteotomy combined with arthroscopic bone marrow stimulation in the treatment of knee osteoarthritis can correct joint force line, improve joint function, create a good environment for medial cartilage regeneration, relieve preoperative pain quickly, and maintain the therapeutic effect.

关 键 词：胫骨 高位截骨术 关节镜 骨髓刺激 膝骨关节炎 

分 类 号：R684.3[医药卫生—骨科学]