[1]杨秋军,吴占勇,孙国栋,等.腓骨近端截骨术治疗内翻型膝关节骨关节炎的疗效研究[J].中华老年骨科与康复电子杂志,2017,(03):167-171.[doi:DOI：10.3877/cma.j.issn.2096-0263.2017.03.007]
　Yang Qiujun,Wu Zhanyong,Sun Guodong,et al.Clinical effect of proximal fibular osteotomy in the treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(03):167-171.[doi:DOI：10.3877/cma.j.issn.2096-0263.2017.03.007]
点击复制

腓骨近端截骨术治疗内翻型膝关节骨关节炎的疗效研究()
分享到：

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03期
页码:
167-171
栏目:
出版日期:
2017-06-01

文章信息/Info

Title:
Clinical effect of proximal fibular osteotomy in the treatment of knee osteoarthritis
作者:
杨秋军 1; 吴占勇 2; 孙国栋 3; 路考生 4
054000 邢台市骨科医院（邢台矿业集团总医院）骨二科 1，院办室 2，骨七科 3，骨八科 4
Author(s):
Yang Qiujun1;  Wu Zhanyong2;  Sun Guodong3;  Lu Kaosheng4
1The Second Department of Orthopedics, 2Headquarter Office, 3the Seventh Department of Orthopedics, 4the Eighth Department of Orthopedics, Xingtai Orthopedic Hospital (Xingtai Mining Group General Hospital), Xingtai 054000, China
关键词:
腓骨;  截骨术;  膝关节;  骨关节炎
Keywords:
Fibular;  Osteotomy;  Knee joint;  Osteoarthritis
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2017.03.007
文献标志码:
A
摘要:
目的 探讨腓骨近端截骨术治疗内翻型膝关节骨关节炎的临床效果。方法 回顾性分析 2014年 10月至 2015年 8月邢台市骨科医院采用腓骨近端截骨术与人工全膝关节置换术（TKA）治疗的内翻型膝关节骨关节炎患者 64例，根据术式不同分为腓骨截骨组（n=30）和 TKA组（n=34）。腓骨截骨组患者男性 6例（20%），女性 24例（80%），平均年龄（53±5）岁。TKA组患者男性 14例（41%），女性 20例（59%），平均年龄（55±3）岁。随访比较两组患者术后 3个月、6个月疼痛视觉模拟评分（VAS）、美国特种外科医院（HSS）膝关节评分、膝关节功能评分（KSS）。结果 64例患者中 62例患者获得满意随访，随访时间为1～8个月，平均（4.2±1.1）个月。术前两组患者的HSS、KSS及VAS评分差异无统计学意义，术后 6 个月腓骨截骨组患者的 HSS 评分、KSS 评分高于 TKA 组，VAS 评分低于 TKA 组（t=-6.812， t=-3.241，t=-9.000，t=4.268，均 P＜0.05）。与术前相比，术后 6 个月时腓骨截骨组患者 VAS 评分由（6.8±1.0）分 降 到（0.8±0.4）分 ，降低 了 88%（F=32.232，P＜0.01）；HSS 评分由（52±13）分升高到（82±8）分，升高了 56%（F=-9.698，P＜0.01）；KSS 临床评分由（54±9）分升高到（87±5）分，升高了 59%（F=-14.187，P＜0.01）。 KSS 功能评分由（50±9）分升高到（81±6）分，升高了 64%（F=-12.151， P＜0.01）。结论 腓骨近端截骨术的近期疗效优于 TKA，且具有创伤小、费用低、功能恢复效果好等优点，能够减轻患者痛苦，在一定程度上改善膝关节功能。
Abstract:
Objective To study the clinical effect of proximal fibular osteotomy in treating knee osteoarthritis. Methods From October 2014 to August 2015, the retrospective analysis was performed in 64 patients underwent proximal fibular osteotomy (PFO) and total knee arthroplasty (TKA). All patients were divided into two groups: the proximal fibular osteotomy group (n=30) and TKA group (n=34). Group PFO included 6 males and 24 females with an average age of 53±5 years. Group TKA included 14 males and 20 females with an average age of 55±3 years. The VAS (visual analogue scale), HSS (hospital for special surgery) and KSS (keen society score) were compared between the two groups at the third and sixth month post-operatively. Results Sixty-two patients received an average of 4.2±1.1 months (range, 1-8 months) of follow- up. There was no statistically significant difference (P>0.05) of HSS, KSS, and VAS between two groups before surgery, while the HSS and KSS score in PFO group was higher than that in TKA group, and theVAS score was lower than that inTKAgroup after surgery (t=-6.812, t=-3.241, t=-9.000, t=4.268, P<0.05). At the final follow-up, VAS score decreased to 0.8±0.4 from preoperative 6.8±1.0 with a percentage of 88% (F=32.232, P<0.01), the HSS score increased to 82±8 from preoperative 52±13 with a percentage of 56% (F=-9.698, P<0.01), the KSS clinical score increased to 87±5 from preoperative 54±9 with 59% (F=-14.187, P<0.01), the KSS functional score increased to 81±6 from preoperative 50±9 with 64% (F=-12.151, P<0.01). Conclusion The effect of PFO is better than TKA in osteoarthritis patients, with little trauma, low costs, knee function improvements et al., it can relieve patients’ pain and guarantee certain keen function.

参考文献/References:

1 Price A, Allum R. Management of osteoarthritis of the knee [J]. Ann R Coll Surg Engl. 2010; 92(6):459-462.
2 Prieto- Alhambra D, Javaid MK, Judge A, et al. Hormone replacement therapy and mid-term implant survival following knee or hip arthroplasty for osteoarthritis: a population-based cohort study [J]. Ann Rheum Dis, 2015, 74(3): 557-563.
3 Meccia B, Komistek RD, Mahfouz M, et al. Abnormal axial rotations in TKA contribute to reduced weightbearing flexion [J]. Clin Orthop Relat Res, 2014, 472(1): 248-253.
4 Harman MK, Banks SA, Kirschner S, et al. Prosthesis alignment affects axial rotation motion after total knee replacement: a prospective in vivo study combining computed tomography and fluoroscopic evaluations [Z]. BMC Musculoskelet Disord. 2012: 13:206.
5 Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD. Can normal knee kinematics be restored with unicompartmental knee replacement [J]? J Bone Joint Surg Am. 2005, 87(2): 332-338.
6 Yang ZY, Chen W, Li CX, et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study [J]. Orthopedics, 2015, 38(12): e1110-e1114.
7 Canale ST, Beaty JH. 坎贝尔骨科手术学第 12 版 [M] . 北京: 人民军医出版社, 2013: 436-446.
8 杨延江, 郑占乐, 李坤, 等. 腓骨高位截骨治疗膝关节骨性关节炎的解剖学研究 [J]. 河北医科大学学报, 2014, 201535(6): 724-725.
9 李涛, 史占军. 膝关节骨关节炎的非置换手术 [J/CD]. 中华老年骨科与康复电子杂志, 2016, 2(1): 1-6.
10 王春生, 金辽沙, 杨佩, 等. 腓骨中上段截除术对踝关节功能的影响 [J/CD]. 中华老年骨科与康复电子杂志, 2016, 2(1): 7-10.
11 马同敏, 张持晨, 杨辉, 等. 腓骨近端段切术治疗严重膝关节骨性关节炎疗效的队列研究 [J]. 中国骨与关节损伤杂志, 2015, 30(6): 595-598.
12 Tan AL, Grainger AJ, Tanner SF, et al. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? [J]. Arthritis Rheum, 2006, 54(4): 1328-1333.
13 李宁华, 张耀南, 张毅, 等. 国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较 [J]. 中国组织工程研究与临床康复, 2007, 11(39): 7758-7760.
14 苗贵强, 谭文成, 吴昊, 等. 玻璃酸钠治疗中度膝关节骨性关节炎的远期疗效 [J]. 暨南大学学报:自然科学与医学版, 2011, 32(2): 218- 220.
15 Moreland LW. Intra- articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action [J]. Arthritis Res Ther, 2003, 5(2): 54-67.
16 郭世绂. 临床骨科解剖学 [M] . 天津: 天津科学技术出版社, 1988: 357-359.
17 王慰年. 人工膝关节：理论基础与临床应用 [M]. 上海: 复旦大学出版社, 2004: 342-343.
18 王飞, 陈百成, 高石军. 膝外摆步态对膝内翻患者股骨-胫骨角及胫股关节外侧间隙的影响 [J]. 中华骨科杂志, 2005, 25(9): 517-519.
19 王飞, 陈百成, 高石军, 等. 胫骨高位截骨手术并发症 23例次分析 [J]. 中国矫形外科杂志, 2006, 14(1): 29-31.
20 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.
21 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.

相似文献/References:

[1]李涛 史占军.膝关节骨关节炎的非置换手术[J].中华老年骨科与康复电子杂志,2016,(01):1.[doi:10.3877/cma.j.issn.2096-0263.2016.01.001]
[2]王春生 金辽沙 杨佩 张子琦 王坤正.腓骨中上段截除术对踝关节功能的影响[J].中华老年骨科与康复电子杂志,2016,(01):7.[doi:10.3877/cma.j.issn.2096-0263.2016.01.002]
　Wang Chunsheng,Jin Liaosha,Yang Pei,et al.Influence of partial resection of middle-upper fibula on ankle joint[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):7.[doi:10.3877/cma.j.issn.2096-0263.2016.01.002]
[3]徐彬 马俊 聂涌 黄泽宇 谭震 裴福兴.腓骨近端截骨术治疗膝关节骨关节炎的早期临床疗效研究[J].中华老年骨科与康复电子杂志,2016,(01):11.[doi:10.3877/cma.j.issn.2096-0263.2016.01.003]
　Xu Bin,MaJun,Nie Yong,et al.Early clinical effect of proximal fibular osteotomy on the treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):11.[doi:10.3877/cma.j.issn.2096-0263.2016.01.003]
[4]周磊 曲铁兵 林源 潘江 王志为 任世祥 陈彤 温亮 张博 马德思.腓骨近端截骨术治疗膝关节骨关节炎的疗效评价[J].中华老年骨科与康复电子杂志,2016,(01):16.[doi:10.3877/cma.j.issn.2096-0263.2016.01.004]
　Zhou Lei,Qu Tiebing,Lin Yuan,et al.Evaluation of proximal fibula osteotomy for treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):16.[doi:10.3877/cma.j.issn.2096-0263.2016.01.004]
[5]王英明 孔荣 禹德万 朱晨 官建中 周建生.腓骨近端截骨联合关节镜下膝关节清理治疗膝关节内侧间室骨关节炎的临床疗效[J].中华老年骨科与康复电子杂志,2016,(01):21.[doi:10.3877/cma.j.issn.2096-0263.2016.01.005]
　Wang Yingming,Kong Rong,Yu Dewan,et al.Effect of proximal fibular osteotomy combined with arthroscopic debridement on medial compartment knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):21.[doi:10.3877/cma.j.issn.2096-0263.2016.01.005]
[6]徐明 付志厚 孙海宁 曲新涛 于秀淳.腓骨近端截骨与单髁关节置换治疗膝关节内侧单间室骨关节炎的疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
　Xu Ming,Fu Zhihou,Sun Haining,et al.Comparison study of proximal fibular osteotomy versus unicompartmental knee arthroplasty for medialcompartment osteoarthritis of the knee[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):26.[doi:10.3877/cma.j.issn.2096-0263.2016.01.006]
[7]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.[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,(03):32.[doi:10.3877/cma.j.issn.2096-0263.2016.01.007]
[8]杨朝君 孙智文 田洪涛.腓骨近端截骨术与人工全膝关节置换术治疗内翻型膝关节骨关节炎的短期疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
　Yang Zhaojun,Sun Zhiwen,Tian Hongtao.Comparison on the short term treatment of varus knee osteoarthritis by proximal fibular osteotomy versus total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(03):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
[9]郑艮强 吴斗 赵恩哲 田亮 郜振武 郑上团 刘强.膝关节周围截骨术对膝关节骨关节炎伴内翻畸形的治疗策略[J].中华老年骨科与康复电子杂志,2016,(01):44.[doi:10.3877/cma.j.issn.2096-0263.2016.01.009]
[10]孙佳冰　付春江　邹吉龙　陈洪均　王旭明　张鹏　毕郑刚.膝关节软骨剥脱分期对腓骨近端截骨治疗膝关节骨关节炎的指导意义[J].中华老年骨科与康复电子杂志,2016,(01):50.[doi:10.3877/cma.j.issn.2096-0263.2016.01.010]
[11]李仕臣,王文革,赵二龙.腓骨近端截骨联合关节镜手术治疗膝关节内侧间室骨关节炎的疗效分析[J].中华老年骨科与康复电子杂志,2017,(04):238.[doi:10.3877/cma.j.issn.2096-0263.2017.04.008]
　Li Shichen,Wang Wenge,Zhao Erlong..Analysis of therapeutic effect of proximal fibula osteotomy combined with arthroscopic surgery on medial compartment knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(03):238.[doi:10.3877/cma.j.issn.2096-0263.2017.04.008]
[12]王坤正.膝关节骨关节炎的创新疗法—腓骨近端截骨术[J].中华老年骨科与康复电子杂志,2018,(03):129.[doi:10.3877/cma.j.issn.2096-0263.2018.03.001]
　Wang Kunzheng.New treatment of keen osteoarthritis- proximal fibula osteotomy[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(03):129.[doi:10.3877/cma.j.issn.2096-0263.2018.03.001]
[13]吴啸波,许博文.腓骨近端切除术相关并发症的研究进展[J].中华老年骨科与康复电子杂志,2018,(03):189.[doi:10.3877/cma.j.issn.2096-0263.2018.03.013]
　Wu Xiaobo,Xu Bowen.Complications related to resection of the proximal fibula: a systematic review[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(03):189.[doi:10.3877/cma.j.issn.2096-0263.2018.03.013]
[14]王秀廷,郭明磊,姜治辉,等.腓骨近端截骨治疗高龄高危膝关节骨性关节炎的疗效分析[J].中华老年骨科与康复电子杂志,2019,(05):269.[doi:10.3877/cma.j.issn.2096-0263.2019.05.005]
　Wang Xiuting,Guo Minglei,Jiang Zhihui,et al.Analysis of proximal fibular osteotomy for the treatment of senile high-risk knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(03):269.[doi:10.3877/cma.j.issn.2096-0263.2019.05.005]

备注/Memo

备注/Memo:
基金项目：冀中能源青年基金（20151001）
更新日期/Last Update: 2017-06-01