改良与传统开放楔形胫骨高位截骨术治疗内翻型膝关节骨关节炎的疗效比较  

Modified versus traditional open wedge high tibial osteotomy for varus knee osteoarthritis

作　　者：李淳朴 范嘉怡 张益 宋文联 孙申杰 戚超[2] 于腾波 陈进利[2] Li Chunpu;Fan Jiayi;Zhang Yi;Song Wenlian;Sun Shenjie;Qi Chao;Yu Tengbo;Chen Jinli(Department of Sports Medicine,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Sports Medicine,The Affiliated Hospital of Qingdao University,Qingdao 266003,China;Shangdong University of Traditional Chinese Medical,Jinan 250355,China;Institute of Sports Medicine and Health,Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛市市立医院运动医学科,青岛266071 [2]青岛大学附属医院运动医学科,青岛266003 [3]山东中医药大学,济南250355 [4]青岛大学运动与康复研究所,青岛266071

出　　处：《中华创伤骨科杂志》2023年第11期944-951,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(31802022)。

摘　　要：目的比较内侧副韧带(MCL)推进骨瓣的改良开放楔形胫骨高位截骨术(MOWHTO)与传统开放楔形胫骨高位截骨术(TOWHTO)治疗内翻型膝关节骨关节炎(KOA)的疗效。方法回顾性分析2019年9月至2020年12月在青岛大学附属医院运动医学科进行胫骨高位截骨术(HTO)治疗的50例(60膝)内翻型KOA的患者资料。根据采用的截骨方式不同分为2组:传统组(采用TOWHTO治疗)25例(30膝)和改良组(采用MCL推进骨瓣的MOWHTO治疗)25例(30膝)。术前及术后18个月测量两组患者髋-膝-踝角(HKAA)、胫骨近端内侧角(MPTA)、关节线汇聚角(JLCA)以评价两术式对下肢力线的纠正情况,同时记录骨折愈合时间、截骨区骨缺损情况、美国特种外科医院(HSS)膝关节功能评分、疼痛视觉模拟评分(VAS)评价术后效果。结果传统组与改良组患者的术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后18个月传统组和改良组的HKAA分别为179.1°±1.1°、179.3°±0.7°,MPTA分别为91.9°±0.4°、91.9°±0.4°,以上观察指标两组间差异均无统计学意义(P>0.05),但均较术前显著改善,差异均有统计学意义(P<0.05)。术后18个月传统组患者的JLCA(1.8°±0.4°)显著大于改良组(1.5°±0.4°),传统组患者的HSS评分[81.5(79.5,83.0)分]显著低于改良组[85.0(82.5,87.5)分],传统组患者的疼痛VAS[1.8(1.6,2.0)分]显著高于改良组[1.5(1.5,2.0)分],以上观察指标两组间差异均有统计学意义(P<0.05)。术后18个月两组患者的JLCA均较术前显著改善,差异均有统计学意义(P<0.05)。传统组与改良组患者的术后骨折愈合评分>4分所需骨折愈合时间分别为(4.5±0.9)、(3.3±0.6)个月,截骨区骨缺损率分别为20%(6/30)、0(0/30),以上项目两组差异均有统计学意义(P<0.05)。结论TOWHTO与MOWHTO均能有效治疗内翻型KOA,MOWHTO在促进截骨区骨愈合,减少截骨区骨缺损及提高膝关节功能等方面疗效更好。Objective To compare the clinical efficacy between modified open wedge high tibial osteotomy(MOWHTO)versus traditional open wedge high tibial osteotomy(TOWHTO)for varus knee osteoarthritis(KOA).Methods A retrospective study was conducted to analyze the 50 patients(60 knees)with varus KOA who had received high tibial osteotomy at Department of Sports Medicine,The Affiliated Hospital of Qingdao University between September 2019 and December 2020.The patients were divided into 2 groups according to different ways of osteotomy:a traditional group and a modified group.In the traditional group subjected to TOWHTO,there were 25 cases(30 knees);in the modified group subjected to MOWHTO,there were 25 cases(30 knees).In MOWHTO,the bone block attached to the medial collateral ligament(MCL)of the knee was first chiseled at the MCL insertion before osteotomy to reduce excessive stripping of the MCL in the osteotomy area,and then the bone fragment attached to the MCL was filled into the osteotomy area to increase bone filling and bone coverage after the alignment of the lower limb was corrected.The hip-knee-ankle angle(HKAA),medioproximal tibial angle(MPTA),and joint line convergence angle(JLCA)were measured preoperatively and at 18 months postoperatively in both groups to evaluate correction of the alignment of the lower limb.Fracture healing time,bone loss in the osteotomy area,Hospital for Special Surgery(HSS)knee score and visual analogue scale(VAS)were recorded to evaluate the postoperative efficacy.Results There was no statistically significant difference between the TOWHTO and MOWHTO groups in the general clinical data before operation,showing comparability(P>0.05).At 18 months after operation,HKAA was(179.1°±1.1°)in the TOWHTO group and(179.3°±0.7°)in the MOWHTO group while MPTA was(91.9°±0.4°)in the TOWHTO group and(91.9°±0.4°)in the MOWHTO group,showing no statistically significant difference between the 2 groups(P>0.05)but a significant difference between preoperation and postoperation in each group(P<0.

关 键 词：骨关节炎 膝 截骨术 内侧副韧带 膝 骨折愈合 

分 类 号：R687.4[医药卫生—骨科学]