腓骨近端截骨术对膝骨关节炎患者膝外侧软组织张力影响的临床研究  

Effect of proximal fibula osteotomy on tension of lateral knee soft tissue in patients with knee osteoarthritis

作　　者：蒋忠华 张浩[1,2,3] 孙骏[1] 顾伟 李志强[1] 卫晓恩[1] JIANG Zhong-hua;ZHANG Hao;SUN Jun;GU Wei;LI Zhi-qiang;WEI Xiao-en(Department of Orthopaedics,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai200021,China;Shi's Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Institute of Traumatology&Orthopedics,Shanghai Academy of Traditional Chinese Medicine,Shanghai203120,China)

机构地区：[1]上海中医药大学附属曙光医院骨科,上海200021 [2]上海中医药大学石氏伤科医学中心,上海200032 [3]上海市中医药研究院骨伤研究所,上海203120

出　　处：《中国骨伤》2023年第10期954-958,共5页China Journal of Orthopaedics and Traumatology

基　　金：上海市慢性筋骨病临床医学研究中心(编号:20MC1920600);上海市临床重点专科“中医骨伤科”(编号:shslczdzk03901);全国中医学术流派传承工作室第二轮建设项目“石氏伤科”、上海中医药大学高峰造尖行动计划高峰高原创新中医骨伤团队、上海市进一步加快中医药事业发展三年行动计划(2018-2020年);海派中医流派传承工程[编号:ZY(2018-2020)-CCCX-1010]。

摘　　要：目的:探讨腓骨近端截骨术治疗膝骨关节炎的短期疗效,分析截骨对患者膝外侧软组织张力影响,验证弓弦理论可靠性。方法:纳入2019年12月至2022年3月收治的内翻型膝骨关节炎患者71例,脱落3例,完成全部试验患者68例,其中男27例,女41例,年龄51~79(68.0±7.0)岁,随访时间4~12(3.76±1.94)周。患者入院后行腓骨近端截骨术治疗,记录患者术前与术后1个月在负重状态下膝外侧软组织张力大小、疼痛视觉模拟评分(visual analogue scale,VAS)、美国Western Ontario and Mc Master大学骨关节炎指数(Western Ontario and Mc Master Universities osteoarthritis index,WOMAC)等指标。结果:根据VAS得分,参照包宗昭等治疗前后评分对单一指标的疗效判断标准评定,显效37例,有效27例,无效4例。术后3例出现足背伸无力,1例出现足背感觉异常,予以对症处理后症状均消失。患者术后1个月VAS、WOMAC评分均小于术前(P<0.001)。患者术后1个月膝外侧软组织张力均小于术前(P<0.001)。结论:腓骨近端截骨术治疗内翻型膝骨关节炎短期内安全有效,截骨后1个月患者在负重状态下膝外侧软组织张力升高,但长期变化仍需进一步观察随访。Objective To evaluate the short-term efficacy of proximal fibula osteotomy in the treatment of knee osteoarthritis,and to analyze the effect of osteotomy on the tension of the lateral knee soft tissue of patients and verify the reliability of the Arch string theory.Methods A total of 71 patients with varus knee osteoarthritis from December 2019 to March 2022 were included,3 patients dropped out,and 68 patients completed all trials,collected 27 males and 41 females,aged from 51 to 79 years old,with an average of(68.0±7.0)years old.The follow-up time ranged from 4 to 12 weeks,with an average of(3.76±1.94)weeks.After admission,the patient underwent Proximal fibula osteotomy,and the tension of lateral knee soft tissue,visual analogue scale(VAS)of pain,the western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and other indicators were recorded before surgery and 1 month after surgery in the weight-bearing state.Results According to the VAS,the curative effect of a single index was evaluated by referring to the score before and after treatment by Bao Zongzhao.Thirty seven cases were markedly effective,27 cases were effective,and 4 cases were ineffective.After surgery,3 patients presented with weakness of dorsalis pedis extension and 1 presented with paresthesia of dorsalis pedis,which disappeared after symptomatic treatment.The VAS and WOMAC score at 1 month after operation were lower than those before operation,and the differences were statistically significant(P<0.001).The tension of lateral knee soft tissue 1 month after operation was lower than that before peration,and the difference had statistical significance(P<0.001).Conclusion Proximal fibula osteotomy is safe and effective in the treatment of varus knee osteoarthritis in the short term.One month after osteotomy,the tension of lateral knee soft tissue increases under weight-bearing state,but the long-term changes still need further observation and follow-up.

关 键 词：膝骨关节炎 软组织张力测定 腓骨近端截骨术 不均匀沉降理论 弓弦理论 

分 类 号：R684.3[医药卫生—骨科学]