[1]姚国军,尹淑梅,赵庆海,等.腓骨近端截骨与关节镜清理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,2017,(02):103-108.[doi:10.3877/cma.j.issn.2096-0263.2017.02.007]
　Yao Guojun,Yin Shumei,Zhao qinghai,et al.Comparative study of proximal fibula osteotomy and arthroscopic debridement in the treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):103-108.[doi:10.3877/cma.j.issn.2096-0263.2017.02.007]
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腓骨近端截骨与关节镜清理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:
2017年02期
页码:
103-108
栏目:
“不均匀沉降理论”在骨关节炎中的应用
出版日期:
2017-03-25

文章信息/Info

Title:
Comparative study of proximal fibula osteotomy and arthroscopic debridement in the treatment of knee osteoarthritis
作者:
姚国军 1; 尹淑梅 1; 赵庆海 1; 梁朝阳 1; 宋洁富 2
041500 临汾，襄汾温泉医院骨科 1；030001 太原，山西省人民医院骨科 2
Author(s):
Yao Guojun1;  Yin Shumei1;  Zhao qinghai1;  Liang Chaoyang1;  Song jiefu2
1Department of orthopedics, Xiangfen hotspring hospital, 041500 linfen, China; 2Department of orthopedics Shanxi People’s Hospital, 030001 Taiyuan, China
关键词:
膝关节;  骨关节炎;  截骨术;  关节镜清理
Keywords:
Knee joint;  Osteoarthritis;  Osteotomy;  Arthroscopic debridement
DOI:
10.3877/cma.j.issn.2096-0263.2017.02.007
文献标志码:
A
摘要:
目的 对比腓骨近端截骨术与关节镜清理术治疗内侧间室性膝关节骨关节炎（KOA）的临床疗效。方法 回顾性收集 2015 年 5 月至 2015 年 9 月襄汾温泉医院收治的符合纳入排除标准的 KOA患者55例，根据术式不同分为腓骨近端截骨组（n=34）与关节镜清理组（n=21），分别于术前、术后7 d、 1个月、6个月、12个月随访，并比较患者手术前后美国特种外科医院（HSS）膝关节评分、疼痛视觉模拟评分（VAS）及膝关节协会评分（KSS），腓骨截骨组手术前后行下肢负重 X线片，观察内侧间隙及下肢力线变化情况。结果 55例患者均获得完整随访，随访时间 12～14个月，平均（13.0±0.7）个月。术前两组患者一般情况及 VAS、KSS临床评分、KSS功能评分比较，差异均无统计学意义。HSS评分比较，腓骨截骨组低于关节镜清理组，差异有统计学意义（F=2.135，P＜0.05）。术后各时间点腓骨截骨组 VAS、HSS 评分均优于关节镜清理组，差异均有统计学意义（F=7.387，F=1.533，P＜0.05），随着时间延长，两组患者 VAS、HSS 评分均逐渐改善，差异均有统计学意义（F=282.434，F=281.892，P＜0.05），组间 KSS 临床评分、KSS功能评分比较差异无统计学意义，但两组术后各时间点 KSS临床评分及 KSS功能评分均逐渐改善，差异均有统计学意义（F=56.991，F=78.360，P＜0.05）。截骨组患者手术前后下肢负重 X线片显示内侧间隙均有不同程度增宽。腓骨截骨组患者有 3例出现术后足背外侧麻木，拇趾背伸无力，5例患者术后自感下肢负重能力下降。关节镜清理组患者有 5例术后 1个月出现关节腔积液。结论 腓骨近端截骨治疗内侧间室疼痛 KOA明显优于关节镜清理术，术后可有效减轻疼痛，改善膝关节功能，手术操作简易、创伤小、风险低，作为治疗 KOA的一种方法，值得临床广泛推广应用。
Abstract:
Objective To compare of clinical efficacy of proximal fibular osteotomy and arthroscopic debridement in the treatment of medial compartment of the knee osteoarthritis (KOA). Methods Fifity-five KOA patients met the inclusion criteria were included from May 2015 to Sep 2015 in Xiangfen hotspring hospital, they were divided into proximal fibular osteotomy group (n=34) and arthroscopic debridement group (n=21), and the hospital for special surgery (HSS) knee score, visual analogue scale (VAS) and Knee Society score (KSS) were respectively followed-up before surgery and at 7 d, 1 months, 6 months, 12 months postoperative. Comparison were done between two groups, the X-ray of lower extremity were done before and after surgery to observe the change of medial compartment space and axial alignment. Results All patients were followed up for 12-14 months (13.0±0.7 months). There were no difference between two groups on VAS, clinical KSS score, KSS function score preoperatively (P>0.05), but the HSS score of fibular osteotomy group was lower than that of the arthroscopic group, with statisticalsignificance (F=2.135, P<0.05). After treatment, the VAS and HSS scores in fibular osteotomy group were higher than ttat in arthroscopic group, with statistical significance (F=7.387, F=1.533, P<0.05), over time, VAS and HSS score gradually improved, with statistical significance (F=282.434, F=281.892, P< 0.05), while no significant differences were observed in clinical and functional KSS score. But the KSS score of both groups were significantly increased over time（F=56.991, F=78.360, P<0.05）. Postoperative X-ray showed the medial compartment space of the fibular osteotomy group were larger in different extend than preoperatively. Postoperative lateral dorsal foot numbness and hallux dorsiflexion weakness occurred in 3 cases of the fibular osteotomy group, 5 patients feel less control of their weight capacity. Five cases in the arthroscopic debridement group had intra- articular effusion at 1 months after operation. Conclusion Proximal fibular osteotomy sustain better clinical efficacy than arthroscopic in the treatment of KOA patients with medial compartment pain, it significantly alleviate pain and improve keen function with easy operation, less trauma and low risk. Proximal fibular osteotomy is worthy for clinical promotion.

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备注/Memo

备注/Memo:
基金项目：山西省自然科学基金（2015011121）
更新日期/Last Update: 2017-04-01