胫骨高位截骨联合关节镜下微骨折术治疗膝关节内侧单间室骨性关节炎

doi:10.3877/cma.j.issn.1673-9450.2017.06.010

中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (06) : 454 -458. doi: 10.3877/cma.j.issn.1673-9450.2017.06.010

所属专题：文献；

论著

胫骨高位截骨联合关节镜下微骨折术治疗膝关节内侧单间室骨性关节炎

吕欣¹, 孙智文¹^,^†(

), 张爱民¹, 杨朝君¹, 郭峰¹, 张志峰²

^1. 024000　内蒙古自治区赤峰市医院骨关节科
^2. 010030　呼和浩特，内蒙古医科大学第二附属医院骨关节科

收稿日期:2017-10-02 出版日期:2017-12-01
通信作者: 孙智文
基金资助:
内蒙古自治区自然科学基金项目(2016MS08130)

High tibial osteotomy combined with arthroscopic microfracture to treat the single compartment osteoarthritis of the medial of knee joint

Xin Lyu¹, Zhiwen Sun¹^,^†(), Aimin Zhang¹, Zhaojun Yang¹, Feng Guo¹, Zhifeng Zhang²

^1. Department of Joint Surgery, Chifeng Municipal Hospital of Inner Mongolia Autonomous Region, Chifeng 024000, China
^2. Department of Joint Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, China

Received:2017-10-02 Published:2017-12-01
Corresponding author: Zhiwen Sun
About author:
Corresponding author: Sun Zhiwen, Email: cfsyyzhiwen@sohu.com

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引用本文：

吕欣, 孙智文, 张爱民, 杨朝君, 郭峰, 张志峰. 胫骨高位截骨联合关节镜下微骨折术治疗膝关节内侧单间室骨性关节炎[J/OL]. 中华损伤与修复杂志(电子版), 2017, 12(06): 454-458.

Xin Lyu, Zhiwen Sun, Aimin Zhang, Zhaojun Yang, Feng Guo, Zhifeng Zhang. High tibial osteotomy combined with arthroscopic microfracture to treat the single compartment osteoarthritis of the medial of knee joint[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(06): 454-458.

目的

研究胫骨高位截骨联合关节镜下微骨折术治疗膝关节内侧单间室骨性关节炎的临床疗效。

方法

选取内蒙古自治区赤峰市医院2012年1月至2014年12月诊断为膝关节内侧单间室骨性关节炎的患者60例，按照单纯随机抽样法分为3组：将行胫骨高位截骨术的患者设为胫骨高位截骨术组(简称截骨术组)，将行关节镜微骨折术的患者设为关节镜微骨折术组(简称微骨折术组)，将行胫骨高位截骨联合关节镜微骨折术的患者设为胫骨高位截骨联合关节镜微骨折术组(简称联合组)，各组均20例。分别评估3组患者术前、术后12个月的视觉模拟评分(VAS)、美国膝关节协会(AKS)评分、美国西大略湖和麦克马斯特大学骨关节炎指数(WOMAC)评分，利用负重膝关节正位X线平片分别测量术前、术后胫骨近端内侧角(MPTA)和股胫角，并对术前、术后进行美国特种外科医院(HSS)膝关节功能评分。数据处理采用配对t检验、方差分析及SNK法。

结果

3组患者术后12个月的VAS、AKS评分、WOMAC评分、HSS评分较术前均有明显改善，差异均有统计学意义(P值均小于0.05)。微骨折术组患者术前、术后12个月MPTA、股胫角比较差异无统计学意义(P值均大于0.05)。联合组患者术前与术后VAS、AKS评分、WOMAC评分、HSS评分、MPTA、股胫角差值为(4.9±0.6) 分、(20.1±5.3) 分、(62.1±7.4) 分、(24.9±11.7) 分、(11.2±2.1)°、(24.2±2.4)°，与截骨术组、微骨折术组比较有明显改善，差异均有统计学意义(P值均小于0.05)。

结论

治疗膝关节内侧单间室骨性关节炎的3种手术方案均可在短期内对患者症状和体征有所改善，但胫骨高位截骨联合关节镜下微骨折术治疗膝关节内侧单间室骨性关节炎可处理关节内病变，同时改善下肢生物学力线，术后效果要明显优于其他两种。

关键词: 胫骨, 截骨术, 关节镜检查, 骨关节炎，膝

Objective

To study the clinical effect of high tibial osteotomy combined with arthroscopic microfracture in the treatment of the single compartment osteoarthritis of the medial compartment lesions of knee joint.

Methods

Sixty patients with the single compartment osteoarthritis of the medial compartment lesions of knee joint were diagnosed from January 2012 to December 2014 in Chifeng Municipal Hospital of Inner Mongolia Autonomous Region, which were divided into 3 groups according to the simple random sampling method. The patients with high tibial osteotomy were established as the high tibial osteotomy group (osteotomy group), the patients with arthroscopic microfracture surgery were treated as arthroscopic microfracture group (microfracture group), the patients with high tibial osteotomy combined with arthroscopic microfracture were established as high tibial osteotomy combined with arthroscopic microfracture surgery group (combined group), and each group were 20 cases. Evaluation of 3 groups of patients before operation, 12 months after surgery, the visual analogue score (VAS), the American Knee Association (AKS)score, the American West Lake and McMaster University Osteoarthritis Index (WOMAC) score were used to measure anterior and posterior tibial proximal medial angle (MPTA) and femoral shank angle, and preoperative and postoperative knee joint scoring (HSS). The data were processed with t test, analysis of variance and SNK test.

Results

The scores of VAS, AKS, WOMAC and HSS for 12 months after operation were significantly improved in the 3 groups and the differences were statistically significant (with P values below 0.05). There were no statistically significant differences between MPTA and femoral shank angles before and after operation in microfracture group (with P values above 0.05). The differences between the preoperative and postoperative of VAS, AKS score, WOMAC score, HSS score and MPTA, femoral shank angle in combined group were (4.9±0.6) points, (20.1±5.3) points, (62.1±7.4) points, (24.9±11.7) points, (11.2±2.1) °, (24.2±2.4) °, which were significantly improved compared with the osteotomy group and the microfracture group(with P values below 0.05).

Conclusions

Three kinds of surgical procedures for the treatment of the single compartment osteoarthritis of the medial knee joint can improve the symptoms and signs of the patients in the short term. However, high tibial osteotomy combined with arthroscopic microfracture treatment can deal with intra articular lesions and improve the biological lines of the lower limbs, and the postoperative effect is significantly better than others.

Key words: Tibia, Osteotomy, Arthroscopy, Osteoarthritis, Knee

表1 3组膝关节内侧单间室骨性关节炎患者术前、术后12个月相关指标比较(n＝20，±s)

组别与时间点		VAS(分)	AKS评分(分)	WOMAC评分(分)	MPTA(°)	股胫角(°)	HSS评分(分)
截骨术组		?	?	?	?	?	?
?	术前	6.8±0.8	69.1±6.2	106.9±10.7	81.8±4.5	187.1±7.4	50.9±14.5
?	术后12个月	2.7±0.9	84.5±5.2	51.2±10.1	91.2±1.5	170.6±2.2	70.3±12.5
?	t值	4.321	14.215	28.684	13.891	15.217	18.241
?	P值	0.009	<0.05	<0.05	<0.05	<0.05	<0.05
微骨折术组		?	?	?	?	?	?
?	术前	7.0±0.9	70.1±8.1	106.8±9.9	82.1±3.7	188.2±4.1	52.3±15.1
?	术后12个月	2.8±0.5	84.7±4.5	50.4±9.8	88.2±1.5	182.6±2.8	71.3±10.5
?	t值	5.679	12.384	26.541	1.195	1.575	15.574
?	P值	0.008	<0.05	<0.05	0.608	0.482	<0.05
联合组		?	?	?	?	?	?
?	术前	6.9±0.5	69.4±5.5	113.1±8.7	82.3±4.1	187.4±2.9	52.1±14.8
?	术后12个月	2.0±0.5	89.1±5.1	51.4±7.8	93.4±3.1	163.2±2.1	76.4±12.6
?	t值	4.587	18.351	26.993	14.671	19.247	19.583
?	P值	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表1 3组膝关节内侧单间室骨性关节炎患者术前、术后12个月相关指标比较(n＝20，±s)

组别与时间点		VAS(分)	AKS评分(分)	WOMAC评分(分)	MPTA(°)	股胫角(°)	HSS评分(分)
截骨术组		?	?	?	?	?	?
?	术前	6.8±0.8	69.1±6.2	106.9±10.7	81.8±4.5	187.1±7.4	50.9±14.5
?	术后12个月	2.7±0.9	84.5±5.2	51.2±10.1	91.2±1.5	170.6±2.2	70.3±12.5
?	t值	4.321	14.215	28.684	13.891	15.217	18.241
?	P值	0.009	<0.05	<0.05	<0.05	<0.05	<0.05
微骨折术组		?	?	?	?	?	?
?	术前	7.0±0.9	70.1±8.1	106.8±9.9	82.1±3.7	188.2±4.1	52.3±15.1
?	术后12个月	2.8±0.5	84.7±4.5	50.4±9.8	88.2±1.5	182.6±2.8	71.3±10.5
?	t值	5.679	12.384	26.541	1.195	1.575	15.574
?	P值	0.008	<0.05	<0.05	0.608	0.482	<0.05
联合组		?	?	?	?	?	?
?	术前	6.9±0.5	69.4±5.5	113.1±8.7	82.3±4.1	187.4±2.9	52.1±14.8
?	术后12个月	2.0±0.5	89.1±5.1	51.4±7.8	93.4±3.1	163.2±2.1	76.4±12.6
?	t值	4.587	18.351	26.993	14.671	19.247	19.583
?	P值	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表2 3组膝关节内侧单间室骨性关节炎患者术前、术后12个月相关指标差值比较(n＝20，±s)

组别	VAS差值(分)	AKS评分差值(分)	WOMAC评分差值(分)	MPTA差值(°)	股胫角差值(°)	HSS评分差值(分)
截骨术组	4.1±0.8	15.4±6.3	55.8±10.9	9.6±2.5	16.8±4.7	19.4±10.2
微骨折术组	4.0±0.8^a	14.9±5.8^a	56.4±7.8^a	6.7±2.9^a	16.0±3.1^a	18.7±12.4^a
联合组	4.9±0.6^bc	20.1±5.3^bc	62.1±7.4^bc	11.2±2.1^bc	24.2±2.4^bc	24.9±11.7^bc
F值	5.659	12.364	8.341	10.839	14.631	6.153
P值	0.021	<0.05	<0.05	<0.05	<0.05	0.001

表2 3组膝关节内侧单间室骨性关节炎患者术前、术后12个月相关指标差值比较(n＝20，±s)

组别	VAS差值(分)	AKS评分差值(分)	WOMAC评分差值(分)	MPTA差值(°)	股胫角差值(°)	HSS评分差值(分)
截骨术组	4.1±0.8	15.4±6.3	55.8±10.9	9.6±2.5	16.8±4.7	19.4±10.2
微骨折术组	4.0±0.8^a	14.9±5.8^a	56.4±7.8^a	6.7±2.9^a	16.0±3.1^a	18.7±12.4^a
联合组	4.9±0.6^bc	20.1±5.3^bc	62.1±7.4^bc	11.2±2.1^bc	24.2±2.4^bc	24.9±11.7^bc
F值	5.659	12.364	8.341	10.839	14.631	6.153
P值	0.021	<0.05	<0.05	<0.05	<0.05	0.001

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High tibial osteotomy combined with arthroscopic microfracture to treat the single compartment osteoarthritis of the medial of knee joint

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High tibial osteotomy combined with arthroscopic microfracture to treat the single compartment osteoarthritis of the medial of knee joint