关节镜联合膝关节周围截骨治疗膝关节单间室骨关节炎的临床疗效

Clinical effect of arthroscopic debridement combined with periarticular knee osteotomy in the treatment of unicompartmental knee osteoarthritis

摘要:

目的 探究关节镜联合膝关节周围截骨在治疗单间室膝关节骨关节炎（KOA）中的临床疗效。方法 回顾性分析2022年6月—2024年8月蚌埠医科大学第二附属医院87例单间室KOA患者，根据治疗方法分为两组，对照组（50例）予以膝关节镜下清理术，观察组（37例）予以膝关节镜下清理术联合膝关节周围截骨术治疗。比较两组围手术期相关指标、疼痛程度、膝关节功能、并发症及生活质量。结果 观察组手术时间长于对照组（P <0.05）。观察组与对照组术前、术后1周和术后4周的静息状态下VAS评分比较，结果 ①不同时间点静息状态下VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组静息状态下VAS评分比较，差异有统计学意义（P <0.05），观察组术后VAS评分较低，相对镇痛效果较好；③两组静息状态下VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组与对照组术前和术后3、6个月的屈曲、伸直活动度比较，结果 ①不同时间屈曲、伸直活动度比较，差异均有统计学意义（P <0.05）；②观察组与对照组屈曲、伸直活动度比较，差异均有统计学意义（P <0.05）；③两组屈曲、伸直活动度变化趋势比较，差异均有统计学意义（P <0.05）。实验组与对照组术前和术后3、6个月的HSS和BBS评分比较，结果 ①不同时间点HSS和BBS评分比较，差异均有统计学意义（P <0.05）；②实验组与对照组HSS和BBS评分比较，差异均有统计学意义（P <0.05）；③两组HSS和BBS评分变化趋势比较，差异均有统计学意义（P <0.05）。观察组治疗后髋-膝-踝角（HKA）高于对照组（P <0.05），股胫角（FTA）均低于对照组（P <0.05）。观察组治疗前后HKA、FTA的差值均大于对照组（P <0.05）。观察组与对照组并发症比较，差异无统计学意义（P >0.05）。观察组治疗后生活质量综合评定问卷（GQOL-74）评分高于对照组（P <0.05）。观察组治疗前后GQOL-74评分的差值均大于对照组（P <0.05）。结论 单间室KOA患者予以关节镜联合膝关节周围截骨治疗，可有效减轻疼痛，促进膝关节功能及活动度恢复，提升生活质量，且较安全。

Abstract:

Objective To explore the clinical effect of arthroscopic debridement combined with periarticular knee osteotomy in the treatment of unicompartmental knee osteoarthritis (KOA).Methods A total of 87 patients with unicompartmental KOA in the Second Affiliated Hospital of Bengbu Medical University from June 2022 to August 2024 were retrospectively selected and divided into two groups based on different treatment methods. The control group (n = 50) underwent arthroscopic debridement of the knee, while the observation group (n = 37) received arthroscopic debridement combined with periarticular knee osteotomy. Perioperative parameters, pain levels, knee joint function, complications, and quality of life were compared between the two groups.Results The operative duration in the observation group was significantly longer than that in the control group (P < 0.05). Repeated measures ANOVA was used to compare VAS scores at rest before surgery, at 1 week after surgery, and at 4 weeks after surgery. The results showed that the VAS scores differed significantly across time points (P < 0.05) and between the two groups (P < 0.05), with the observation group showing lower postoperative VAS scores and better analgesic effects. The change trends of VAS scores also differed significantly between the groups (P < 0.05). Repeated measures ANOVA was also used to compare knee flexion and extension ranges of motion before surgery and at 3 and 6 months postoperatively. The results indicated that flexion and extension ranges differed significantly across time points (P < 0.05) and between the two groups (P < 0.05), and that the change trends in flexion and extension ranges also differed significantly between the groups (P < 0.05). Similarly, repeated measures ANOVA was used to compare HSS and BBS scores before surgery and at 3 and 6 months postoperatively. The results showed that HSS and BBS scores differed significantly across time points (P < 0.05) and between the two groups (P < 0.05), and that the change trends also differed significantly between groups (P < 0.05). After treatment, HKA values in the observation group were significantly higher than those in the control group (P < 0.05), whereas FTA values were significantly lower (P < 0.05). The changes in HKA and FTA before and after treatment were greater in the observation group than in the control group (P < 0.05). There was no significant difference in complication rates between the two groups (P > 0.05). After treatment, GQOL-74 scores were significantly higher in the observation group compared with the control group (P < 0.05), and the pre- to post-treatment change in GQOL-74 scores was also greater in the observation group (P < 0.05).Conclusion For patients with unicompartmental KOA, arthroscopic debridement combined with periarticular knee osteotomy can effectively reduce pain, promote the recovery of knee function and range of motion, improve quality of life, and demonstrate good safety.