开放楔胫骨高位截骨术治疗膝关节前内侧骨关节炎临床疗效研究  

Clinical effect of open wedge high tibial osteotomy on antero medial osteoarthritis of knee joint

作　　者：王玉武 方加虎[2] 朱文峰 洪瑞龙 陈鹏[1] 柴盛德 WANG Yuwu;FANG Jiahu;ZHU Wenfeng;HONG Ruilong;CHEN Peng;CHAI Shengde(Yancheng Clinical Medical College Affiliated to Nanjing Medical University,Yancheng 224000,China)

机构地区：[1]南京医科大学附属盐城临床医学院盐城市第三人民医院,江苏盐城224000 [2]南京医科大学第一附属医院骨科,江苏南京210029 [3]伊犁哈萨克自治州察布查尔锡伯自治县人民医院骨科,新疆察布查尔锡伯835300

出　　处：《陕西医学杂志》2023年第8期1014-1018,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(82172519)。

摘　　要：目的:探讨开放楔胫骨高位截骨术(OWHTO)治疗膝关节前内侧骨关节炎(AMOA)的临床疗效。方法:选取AMOA患者94例,随机分为两组,其中41例单纯行关节镜下清理术(关节镜组),53例在关节镜检查与清理基础上行OWHTO治疗(OWHTO组),比较两组手术前后放射学参数、膝前痛症状、膝关节功能与髌股关节OA病程进展情况。结果:OWHTO组术后6个月优良率高于关节镜组(P<0.05);OWHTO组术后股胫角、CD指数比术前减小,且小于关节镜组(均P<0.05);OWHTO组胫骨内侧近端角、负重位力线、髌骨外倾角比术前增大,且大于关节镜组(均P<0.05);两组术后6个月膝前痛发生率低于术前,术后3、6个月VAS评分低于术前(均P<0.05),但组间比较差异均无统计学意义(均P>0.05);两组术后6个月Lysholm评分、HSS评分高于术前(均P<0.05),且OWHTO组高于关节镜组(均P<0.05);两组手术后髌股关节K-L分级与术前比较无统计学差异,且组间比较差异无统计学意义(P>0.05)。结论:OWHTO手术可导致髌骨位置降低及外倾,但未增加膝前痛症状,其对膝关节功能的改善效果优于关节镜手术。Objective:To investigate the therapeutic effect of open wedge tibial high osteotomy(OWHTO)on antero medial osteoarthritis(AMOA)of the knee.Methods:A total of 94 patients with AMOA were selected and divided into two groups according to surgical methods.Among them,41 patients underwent simple arthroscopic debridement surgery(arthroscopic group),and 53 patients underwent OWHTO treatment on the basis of arthroscopic examination and debridement(OWHTO group).The radiological parameters,anterior knee pain symptoms,knee joint function,and the progression of patellofemoral joint OA before and after surgery were compared between the two groups.Results:The excellent and good rate in the OWHTO group 6 months after surgery was higher than that in the arthroscopic group(P<0.05).After surgery,the femoral tibial angle and CD index in the OWHTO group decreased compared with those before surgery,and were smaller than those in the arthroscopy group(all P<0.05).The medial proximal angle of the tibia,weight-bearing force line,and patellar inclination angle in the OWHTO group increased compared with those before surgery,and were greater than those in the arthroscopic group(all P<0.05).The incidence of anterior knee pain 6 months after surgery was lower than before surgery,and VAS score 3 and 6 months after surgery was lower than that before surgery(all P<0.05),but there was no statistical significance between the two groups(all P>0.05).Lysholm scores and HSS scores in both groups 6 months after surgery were higher than those before surgery,and the OWHTO group was higher than the arthroscopic group(all P<0.05).There was no significant difference in the K-L grading of the patellofemoral joint between the two groups before and after surgery,and there was no statistically significant difference between the groups(all P>0.05).Conclusion:OWHTO surgery can lead to a decrease in patellar position and extraversion,but does not increase symptoms of knee anterior pain.Its improvement effect on knee joint function is superior to arthroscopic surg

关 键 词：膝骨关节炎 膝内翻 髌股关节 开放楔胫骨高位截骨术 疼痛 关节功能 

分 类 号：R684[医药卫生—骨科学]