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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:

2023年04期

页码:

218-225

栏目:

膝关节

出版日期:

2023-08-05

文章信息/Info

Title:

Arthroscopic study on the effectiveness of high tibial osteotomy for knee osteoarthritis

作者:

张镇斌1; 闫兆龙1; 王功腾1; 张文琦1; 王旭凤2; 李广兴2; 孙华强1; 李树锋1

250014 山东第一医科大学第一附属医院（山东省千佛山医院）骨科，山东省风湿病与转化医学重点实验室1；250013 山东中医药大学第一临床医学院2

Author(s):

Zhang Zhenbin1, Yan Zhaolong1, Wang Gongteng1, Zhang Wenqi1, Wang Xufeng2, Li Guangxing2, Sun Huaqiang1, Li Shufeng.

关键词:

膝骨关节炎;  胫骨高位截骨术;  关节镜;  手术效果;  影响因素

Keywords:

Knee osteoarthritis;  High tibial osteotomy;  Arthroscopy;  Surgical effect;  Influencing factors

DOI:

10.3877/cma.j.issn.2096-0263.2023.04.004

文献标志码:

A

摘要:

目的 探讨关节镜对胫骨高位截骨术（HTO）的效果研究。方法 回顾性分析2018.01至2022.03在山东第一医科大学第一附属医院行HTO的患者，根据纳入与排除的标准共纳入142名患者，其中男70例（49.3%），女72例（50.7%），平均年龄（53.62±0.39）岁，168侧患肢。根据患者行HTO有无联合关节镜分为两组（HTO组；HTO联合关节镜组）。测量胫骨近端内侧角（MPTA），关节线夹角（JLCA），髋-膝-踝角（HKA），股骨胫股角（FTA），膝关节负重线比值，撑开距离，撑开角度，美国特种外科医院评分（HSS）、美国膝关节协会评分（KSS）、美国西部Ontario和McMaster大学骨关节炎指数评分（WOMAC）、Lysholm评分。通过Logistic回归分析，研究关节镜在HTO手术中的效果，来确定关节镜是否是HTO手术效果的影响因素。结果 HTO联合关节镜与不联合关节镜两组患者术后功能评分和影像学指标均较术前有明显改善（术后MPTA较术前增大，JLCA减小、FTA减小，HKA角增大，WBL%增大；术后HSS评分、KSS评分、Lysholm评分明显增高，WOMAC评分降低）。多因素分析显示，关节镜和术前WOMAC评分均为影响手术效果的独立影响因素，HTO联合关节镜组术后Lysholm评分被归类为优的概率是HTO组术后的4.037倍[OR=4.037，95% CI：1.555，10.480，P=0.004]；术前WOMAC评分每增加一个单位，术后Lysholm评分被归类为优的概率是原来的0.939倍[OR=0.939，95% CI：0.906，0.973），P=0.000]。结论 HTO联合关节镜术后功能评分及影像学指标较术前均得到明显改善。关节镜及术前WOMAC评分是影响HTO手术效果的影响因素；术前WOMAC评分越高的患者，术后膝关节功能恢复越差，HTO联合关节镜组的患者术后功能评分和功能恢复较不联合关节镜组的患者要更好。

Abstract:

Objective Study on the effectiveness of arthroscopy for high tibial osteotomy (HTO). Methods A retrospective study of patients who underwent HTO at the First Affiliated Hospital of Shandong First Medical University from 2018.01-2022.03, and a total of 142 patients were included according to the inclusion and exclusion criteria, of whom 70 (49.3%) were male and 72 (50.7%) were female, with a mean age of 53.62±0.388 years and 168 affected limbs. Patients were divided into two groups (HTO group; HTO combined with arthroscopy group) according to whether they underwent HTO with or without combined arthroscopy. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), hip-knee-ankle (HKA) angle, femoral tibial angle (FTA), weight-bearing line (WBL) ratio of the knee joint，opening gap，opening angle, US Hospital for Special Surgery (HSS) score, American Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lysholm score. The effect of arthroscopy in HTO surgery was studied by logistic regression analysis to determine whether arthroscopy is an influential factor in the outcome of HTO surgery. Results Both groups of patients with and without HTO combined with arthroscopy showed significant improvement in functional scores and imaging indexes after surgery compared with preoperative scores(Postoperatively, MPTA increased compared to preoperative, JLCA decreased, FTA decreased, HKA angle increased, and WBL% increased; postoperatively, HSS score, KSS score, and Lysholm score increased significantly, and WOMAC score decreased). Multifactorial analysis showed that both arthroscopic and preoperative WOMAC scores were independent influences on the outcome of the procedure, and the probability of Lysholm score being classified as excellent after surgery in the HTO combined arthroscopy group was 4.037 times greater than that in the HTO group postoperatively [OR=4.037, 95% CI: 1.555, 10.480, P=0.004]; each unit increase in preoperative WOMAC score was associated with 0.939 times greater probability of postoperative Lysholm score being classified as excellent [OR=0.939, 95% CI: 0.906, 0.973, P=0.000]. Conclusions Functional scores and imaging indexes were significantly improved after HTO combined with arthroscopy compared with preoperative scores. Arthroscopic and preoperative WOMAC scores were influential factors in the outcome of HTO surgery; patients with higher preoperative WOMAC scores had poorer postoperative functional recovery of the knee, and patients in the HTO combined arthroscopy group had better postoperative functional scores and functional recovery than those in the non-combined arthroscopy group.

备注/Memo

备注/Memo:

基金项目：山东省自然科学基金资助项目（ZR2022MH128）

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更新日期/Last Update: 2023-09-01