膝关节镜清理联合腓骨近端截骨在膝内侧间室病变骨关节炎治疗中的临床研究

Clinical research on medial compartment knee osteoarthritis treated with proximal fibular osteotomy combined with arthroscopic debridement

摘要:

目的 比较膝关节镜清理联合腓骨近端截骨与单纯膝关节镜清理治疗内侧间室病变膝关节骨性关 节炎的临床疗效。方法 回顾性分析该院2014 年1 月-2015 年12 月收治的部分早中期内侧间室受累为主的 膝关节骨性关节炎病例。根据术式分为治疗组（20 例）：膝关节镜清理联合腓骨近端截骨；对照组（23 例）： 单纯膝关节镜清理。分别于术前、术后2 d、术后12 个月记录治疗组、对照组的美国特种外科医院（HSS）评 分、视觉模拟评分（VAS）、关节活动度（ROM）及胫股角（FTA）。对其进行组间和组内比较，观察并发症情况。 结果 两组术前、术后2 d、术后12 个月比较采用重复测量设计的方差分析：①两组不同时间的HSS 膝关节评分、 VAS 评分、ROM、FTA 差异有统计学意义（P <0.05）；②两组间的HSS 膝关节评分、VAS、ROM、FTA 差异有统计学意义（P <0.05），治疗组患者在术后的治疗效果更好；③两组的HSS 膝关节评分、VAS 评分、 ROM、FTA 变化趋势有差异（P <0.05）。结论 关节镜清理联合腓骨近端截骨手术相较胫骨高位截骨、膝关节 单髁置换及全膝关节置换等手术治疗方式，具备手术费用低、操作过程简单及创伤小等特点，对符合适应证的 人群可有效改善临床症状，减轻患者疼痛，值得推广。

Abstract:

Objective To compare the clinical effect of proximal fibular osteotomy combined with arthroscopic debridement and arthroscopic debridement in the treatment of medial compartment knee osteoarthritis. Methods From January 2014 to December 2015, 20 patients suffered proximal fibular osteotomy combined with arthroscopic debridement were divided into treatment group; and 23 patients suffered arthroscopic debridement were divided into control group. Visual analogue score (VAS), hospital for special surgery (HSS) knee score, range of motion (ROM) and femur tibia angle (FTA) were measured separately pre-operation and 2 days and 12 months post-operation. Comparison was made and complications were observed between the groups. Results Variance analysis of repeated measurement design was compared between the groups pre- and 2 days and 12 months post-operation. HSS score, VAS score, ROM angle and FTA angle were significant different at different times (P < 0.05). HSS score, VAS score, ROM angle and FTA angle of the treatment group were different from those of the control group, and effect of the treatment group were better than that of the control group (P < 0.05). The variation trends of HSS score, VAS score, ROM angle and FTA angle between the treatment group and the control group were different (P < 0.05). Conclusions The advantages of proximal fibular osteotomy combined with arthroscopic debridement include low cost, simple surgical procedure and minimal invasion, which can effectively improve the clinical symptoms and reduce pain of the patients.