[1]李博　李计东　刘丽君　曲磊　刘丽霞　贾媛媛　王海红　刘军.腓骨近端截骨术与口服药物治疗膝关节骨关节炎的对比研究[J].中华老年骨科与康复电子杂志,2016,(01):32-37.[doi:10.3877/cma.j.issn.2096-0263.2016.01.007]
　Li Bo,Li Jidong,Liu Lijun,et al.Therapeutic effect analysis of proximal fibular osteotomy for the treatment of patients withknee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):32-37.[doi:10.3877/cma.j.issn.2096-0263.2016.01.007]
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腓骨近端截骨术与口服药物治疗膝关节骨关节炎的对比研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2016年01期
页码:
32-37
栏目:
临床论著
出版日期:
2016-02-05

文章信息/Info

Title:
Therapeutic effect analysis of proximal fibular osteotomy for the treatment of patients withknee osteoarthritis
作者:
李博　李计东　刘丽君　曲磊　刘丽霞　贾媛媛　王海红　刘军
井陉县医院骨科
Author(s):
Li Bo;  Li Jidong;  Liu Lijun;  Qu Lei;  Liu Lixia;  Jia Yuanyuan;  Wang Haihong;  LiuJun
Department of Orthopaedic Surgery, Jingxing County Hospital, Shi Jiazhuang 050300, China
关键词:
膝关节; 　骨关节炎; 　腓骨; 　截骨术; 　药物治疗
Keywords:
Knee joint; 　 Osteoarthritis;  　Fibula;  　Osteotomy;  　Drug therapy
DOI:
10.3877/cma.j.issn.2096-0263.2016.01.007
摘要:
目的　探讨腓骨近端截骨术治疗膝关节骨关节炎患者的临床疗效。方法　回顾性收集2012 年11 月至2015 年11 月井陉县医院收治的符合纳入及排除标准的膝关节骨关节炎患者341例，根据治疗方法不同分为腓骨截骨组（n=171）和口服药物组（n=170）。腓骨截骨组患者采用患侧腓骨近端截骨术，口服药物组则给予口服非甾体抗炎药、氨基葡萄糖。分别于术后1 周、1 个月、3 个月、12 个月，随访并比较两组患者美国特种外科医院（hospital for special surgery，HSS）膝关节评分、疼痛视觉模拟评分（visual analogue scale，VAS）、曼彻斯特大学关节炎指数（western ontarioand McMaster Universities osteoarthritis index，WOMAC）、内侧间室高度及胫股角的变化。结果　341例患者均获得满意随访，随访时间12 ～ 16 个月，平均13 个月。术前两组患者的HSS、VAS 评分及胫股角差异无统计学意义（P ＞ 0.05），且腓骨截骨组WOMAC 评分高于口服药物组，内侧间室高度低于口服药物组（P ＜ 0.05）。术后1 个月、3 个月、12 个月时腓骨截骨组VAS 及WOMAC 评分均低于口服药物组患者（P ＜ 0.05），HSS 评分及内侧间室高度均高于口服药物组患者（P ＜ 0.05）；与术前相比，腓骨截骨组患者的HSS、VAS、WOMAC 评分及内侧间室高度、胫股角均明显改善，差异有统计学意义（P ＜ 0.05），口服药物组患者的各指标改善不明显，差异无统计学意义（P ＞0.05）。但腓骨截骨组中有5 例（2.9%）患者于术后第1 天出现腓总神经损伤，以足背感觉障碍，拇背伸不能为主，其中1 例（0.05%）行肌腱移位，余均自行恢复。结论　腓骨近端截骨术治疗膝关节骨关节炎效果优于口服药物，可有效改善膝关节功能、缓解膝关节内侧疼痛，费用较低、出血量较少，是值得推广的手术方式。
Abstract:
Objective　To investigate the clinical efficacy of proximal fibular osteotomyfor the treatment of patients with knee osteoarthritis. Methods　341 patients with knee osteoarthritiswho were treated in Jingxing County Hospital from November 2015 to November 2012 were collectedretrospectively. According to different treatment methods, the patients were divided into the fibularosteotomy group (n=171) and the oral medication group (n=170). The fibular osteotomy group were treatedwith the ipsilateral proximal fibular osteotomy, oral medicine group were given oral non steroidal antiinflammatorydrugs, glucosamine. The hospital for special surgery (HSS) knee score, the visual analoguescale (VAS), the western ontario and McMaster Universities osteoarthritis index (WOMAC), and thechanges of the medial compartment height and the femorotibial angle of the patients in these two groups were followed-up and made comparison 1 week, 1 month, 3 months, and 12 months after the operationrespectively. Results　341 patients were followed up for 12 to 16 months, with an average of 13 months.The HSS, VAS and the femorotibial angle of patients preoperatively showed no statistically significantdifference between two groups (P>0.05), the WOMAC score of proximal fibula osteotomy group washigher than that of the oral drug group, the medial tibiofemoral compartment height of proximal fibulaosteotomy group was lower than that of the oral drug group (P<0.05). The WOMAC and VAS score ofpatients treated 1 month, 3 months, 12 months after proximal fibula osteotomy was lower than that of theoral drug group (P<0.05). The HSS score and the medial compartment height of patients treated 1 month,3 months, 12 months after proximal fibula osteotomy were both higher than that of the oral drug group;The WOMAC score of patients treated 1 month, 3 months, 12 months after proximal fibula osteotomywas lower than that of the oral drug group (P<0.05). Compared with the preoperative values, the HSS,VAS, WOMAC score, medial tibiofemoral compartment height, and femorotibial angle in proximal fibularosteotomy group were all significantly improved, and the difference was statistically significant (P<0.05).On the contrary, there were no statistically significant differences in terms of these values in the oral druggroup (P>0.05), indicating no significant improvement of symptom recovery. However, 5 cases in thesurgery group (2.9%) showed peroneal nerve injury, dorsal sensory disturbances, and hallux dorsiflexiondisablement on the first day after surgery, in which one case (0.05%) underwent transposition of tendon,and the rest were spontaneously recovered. Conclusions　The therapeutic effect of proximal fibularosteotomy for the treatment of knee osteoarthritis is better than that of oral drug treatment, which caneffectively alleviate the medial knee pain withlow cost, less bleeding, and effectively improve the functionof knee joint, recover the medial compartment height and femorotibial angle. Thus, it is an alternativeoperation for the treatment of knee osteoarthritis, which is easily accepted by doctors and patients andworth popularizing.

参考文献/References:

1 刘伟伟, 林炜栋, 钱雄, 等. 降钙素联合透明质酸钠治疗绝经后女性膝关节骨性关节炎的疗效分析 [J]. 中国骨与关节损伤杂志,2014 (2): 147-149.
2 Cao K, Wei L, Zhang Z, et al. Decreased histone deacetylase 4is associated with human osteoarthritis cartilage degeneration byreleasing histone deacetylase 4 inhibitioon of runt-related transcriptionfactor-2 and increasing osteoarthritis-related genes:a novel mechanismof human osteoarthritis cartilage degeneration [J]. Arthritis Res Ther,2014, 16(6): 491.
3 Piao T, Ma Z, Li X, et al. Taraxasterol inhibits IL-1β-inducedinflammatory response in human osteoarthritic chondrocytes [J]. Eur JPharmacol, 2015, 756: 38-42.
4 张英泽, 李存祥, 李冀东, 等. 不均匀沉降在膝关节退变及内翻过程中机制的研究 [J]. 河北医科大学学报, 2014, 35(2): 218-219.
5 李茂强, 史晨辉, 王永明, 等. 骨关节炎的实验研究现况与进展 [J].农垦医学, 2004, 26(1): 29-32.
6 黄公怡. 骨质疏松性骨折及临床特点[J]. 中华骨科杂志, 2008,28(1): 74-77.
7 高彤, 吕厚山, 关振鹏, 等. 人工全膝关节置换术医疗费用调查 [J].中华骨科杂志, 2003 (6): 52-55.
8 陈伟, 陈百成, 王飞, 等. 应用不同方法治疗膝关节骨性关节炎的对比研究 [J]. 河北医科大学学报, 2015, 36(5): 600-602.
9 O’dwyer KJ. Chakravarty RD,Esler CN.Intramedullary nailingtechnique and its effect on union rates of tibial shaft fractures [J].Injury, 1994, 25(7): 461-464.
10 叶俊星, 白书臣, 吉璐宏, 等. 骨性关节炎的治疗进展 [J]. 湖北中医杂志, 2006, 28(11): 55-57.
11 Yang ZY, Chen W, Li CX, et al. Medial compartment decompressionby fibular osteotomy to treat medial compartment knee osteoarthritis: apilot study [J]. Orthopedics , 2015, 38 (12): 1110-1114.

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更新日期/Last Update: 2016-02-16