胫骨内侧高位截骨术治疗膝骨关节炎的疗效及对膝关节外侧间室软骨病变的影响  

The influence of medial high tibial osteotomy on the effect of knee osteoarthritis and cartilage lesion of knee joint lateral compartment

作　　者：苏柯[1] 王庆海[1] 桑卫华 王军[1] 马世云[1] 靳胜利[1] SU Ke;WANG Qing-hai;SANG Wei-hua;WANG Jun;MA Shi-yun;JIN Sheng-li(Center of Joint Surgery,Cangzhou Central Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市中心医院关节外科中心,河北沧州061000

出　　处：《临床骨科杂志》2024年第2期204-208,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨胫骨内侧高位截骨术治疗膝骨关节炎的疗效及对膝关节外侧间室软骨病变的影响。方法采用胫骨内侧高位截骨术治疗104例单侧内翻型膝骨关节炎患者,取出内固定时再次行关节镜探查膝关节外侧间室的软骨病变进展。根据截骨术时膝关节外侧间室软骨病变分级将患者分为A组(OuterbridgeⅠ度,41例)、B组(OuterbridgeⅡ度,35例)、C组(OuterbridgeⅢ度,28例)。记录疼痛VAS评分、Lysholm评分、WOMAC评分、再次手术时膝关节外侧间室软骨病变的变化。结果患者均获得随访,时间12~32(20.19±4.65)个月。3组疼痛VAS评分、Lysholm评分和WOMAC评分再次手术前均较初次手术前改善(P<0.05)。再次手术前,疼痛VAS评分A组和B组比较差异无统计学意义(P>0.05),且均优于C组(P<0.05);3组Lysholm评分和WOMAC评分比较差异均无统计学意义(P>0.05)。3组膝关节外侧间室软骨病变最大直径再次手术时与初次手术时比较差异均无统计学意义(P>0.05)。结论对膝关节外侧间室软骨OuterbridgeⅠ~Ⅲ度病变患者行胫骨内侧高位截骨术,不会增加外侧间室的软骨退变,仍能获得较为满意的临床效果。Objective To investigate the influence of medial high tibial osteotomy(HTO)on the effect of knee osteoarthritis and cartilage lesion of knee joint lateral compartment.Methods A total of 104 patients who suffered from unilateral varus knee osteoarthritis were treated by medial HTO.Arthroscopy was performed again to explore the progression of cartilage lesions in the lateral compartment of the knee joints.They were divided into three groups according to the cartilage lesion grading of knee joint lateral compartment at osteotomy,group A(Outerbridge degree-Ⅰ,41 cases),group B(Outerbridge degree-Ⅱ,35 cases)and group C(Outerbridge degree-Ⅲ,28 cases).The pan VAS,Lysholm scores,WOMAC scores and the cartilage lesion changes of the knee joint lateral compartment in the re-operation were recorded.Results All cases were followed up for 12~32(20.19±4.65)months.The pain VAS,Lysholm scores,WOMAC scores of the three groups were improved in the re-operation than the primary surgery(P<0.05).Before the re-operation,there was no statistical difference in pain VAS between groups A and B(P>0.05),but both groups were better than group C(P<0.05),there were no statistical differences in Lysholm scores and WOMAC scores among three groups(P>0.05).Among three groups,the maximum diameter of cartilage lesion of the knee joint lateral compartment had no differences between the secondary operation and the primary surgery(P>0.05).Conclusions For the patients with cartilage lesion(Outerbridge degreeⅠ~Ⅲ)in the lateral compartment of the knee joint,HTO does not increase the cartilage degeneration of lateral compartment,it can still obtain more satisfactory clinical effect.

关 键 词：胫骨高位截骨 膝骨关节炎 膝内翻 关节镜检查 

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