胫骨高位双平面上行截骨与下行截骨治疗内翻型膝关节骨性关节炎效果及步态分析*

目的探讨胫骨高位双平面上行截骨与下行截骨治疗内翻型膝关节骨性关节炎的效果及步态分析。方法遴选出2017年1月至2019年6月因内翻型膝关节骨性关节炎住院患者32例,按手术方式分为胫骨高位双平面上行截骨组和下行截骨组,以观察两组患者的膝关节HSS评分、VAS评分、胫股角(FTA)、胫骨后倾角、InsallSalvati指数(髌骨高度)的变化,以及两组患者的步态时空参数、步态运动参数、步态运动力学参数变化。结果术后半年两组患者的HSS评分、VAS评分、胫股角、胫骨后倾角、Insall-Salvati指数组内与术前相比差异均具有统计学意义(P<0.05),两组患者术后半年的Insall-Salvati指数组间相比差异具有统计学意义(P<0.05)。两组患者步态时空参数包括步速、步频、步幅、步态周期比较中,术后半年组内各指标较术前相比差异均具有统计学意义(P<0.05),两组患者术后半年的步速、步幅组间比较差异具有统计学意义(P<0.05)。两组患者步态运动参数包括支撑相最大屈曲角度、支撑相最小屈曲角度、支撑相中期伸直角度、摆动相屈曲角度比较中,术后半年两组组内较术前比较各指标差异均具有统计学意义(P<0.05),而术后半年组间比较差异均无统计学意义(P>0.05)。两组患者步态运动力学参数即内收力矩比较中,术后半年两组组内较术前相比差异均具有统计学意义(P<0.05),而术后半年两组患者膝关节内收力矩组间相比差异无统计学意义(P>0.05)。结论胫骨高位截骨术能明显改善膝关节骨性关节炎患者步态,而胫骨高位双平面下行截骨对于保留髌骨高度更具有优势。

Analysis of the effect and gait analysis of biplane ascending high tibial osteotomy and descending osteotomy for varus knee osteoarthritis

Objective To investigate the effect and gait analysis of the treatment of biplane ascending high tibial osteotomy and descending osteotomy for varus knee osteoarthritis. Methods A total of 32 hospitalized patients with inverted knee osteoarthritis from January 2017 to June 2019 were selected. They were divided into two groups according to the surgical method. The HSS knee function score, VAS score, femoral tibial angle (FTA), tibial posterior slope, Insall-Salvati index (patella height) changes, and changes in gait time and space parameters, gait motion parameters, and gait motion mechanics parameters of the two groups were observed. Results The HSS knee function score, VAS score, femoral tibial angle, tibial posterior slope, and Insall-Salvati index of the two groups of patients six months after the operation were significantly different from those of the preoperative group (P<0.05). The Insall-Salvati index in the second half of the year was statistically significant (P<0.05). In the comparison of the gait time and space parameters of the two groups of patients, including gait speed, gait frequency, stride length, and gait cycle, the differences in each index in the group six months after the operation were statistically significant (P<0.05). There were statistically significant differences in the pace and stride length of the patients in the six months after the operation (P<0.05). The gait motion parameters of the two groups of patients include the maximum flexion angle of the support phase, the minimum flexion angle of the support phase, the mid-support phase extension angle, and the swing phase flexion angle. In the comparison of the two groups six months after the operation, there are differences in the indicators compared with the preoperative comparison. It was statistically significant (P<0.05), and there was no statistically significant difference between the groups six months after the operation (P>0.05). In the comparison of the gait motion mechanics parameter, that is, the adduction torque, the difference between the two groups in the six months after the operation was statistically significant (P<0.05), and the knee joint adduction in the two groups was six months after the operation. There was no statistically significant difference between the torque groups (P>0.05). Conclusion High tibial osteotomy can significantly improve the gait of patients with knee osteoarthritis, and high tibial biplane osteotomy is more advantageous for preserving the height of the patella.