关节镜下清理联合腓骨近端截骨治疗中老年膝关节骨性关节炎

目的 探讨应用膝关节镜清理联合腓骨近端截骨治疗中老年膝关节骨性关节炎(knee osteoarthritis,KOA)的初期临床疗效.方法 对2014年12月至2016年1月柳州市工人医院骨科收治的内侧间室型KOA的16例病人进行回顾性分析,其中男6例,女10例,年龄为58～74岁.记录16例病人术前、术后1 d及随访期间的疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分及美国膝关节协会评分(American Knee Society Score,KSS)的变化.结果 本组随访时间为5～15个月.末次随访时,下肢力线股胫角由术前的182.77°±0.87°降低到179.61°±2.18°,差异有统计学意义(t=7.666,P<0.001);VAS评分较术前显著下降,差异具有统计学意义(Z=3.564,P<0.001);HSS评分由术前(58.88±4.13)分提高到(70.38±5.66)分,差异有统计学意义(t=-8.632,P<0.001);KSS评分由术前(62.38±2.00)分提高到(78.63±6.67)分,差异有统计学意义(t=-9.733,P<0.001).结论 关节镜下清理联合腓骨近端截骨治疗中老年KOA可减轻病人疼痛,改善下肢力线和膝关节功能,手术操作简单、创伤小,初期临床疗效显著.

Evaluation of arthriscopic debridement combined with proximal fibula osteotomy for treatment of knee osteoarthritis

Objective To evaluate short-term effect of arthriscopic debridement combined with proximal fibula osteotomy in the treatment of knee osteoarthritis (KOA). Methods From December 2014 to January 2016, 16 patients with medial compartment KOA treated by arthriscopic debridement combined with proximal fibula osteotomy were analyzed retrospectively, including 6 males and 10 females with an average age of 66.3 years (range 58-74 years). The visual analogue scale (VAS) of the knee joint, Hospital for Special Surgery (HSS) knee score, the American Knee Society Score (KSS) and the femorotibial angle (FTA) measured by anteroposterior and lateral weight-bearing radiographs were evaluated before and one day after operation, and during the follow-up period. Results All 16 patients were followed up for 5-15 months. At the final follow-up, mean postoperative FTA was 179.61° ± 2.18° , significantly smaller than that measured preoperatively (182.77° ± 0.87° ) (t=7.666, P<0.001). The VAS at the last follow-up was significantly lower than that preoperation (Z=3.564, P<0.001). The HSS knee score and KSS were 70.38 ± 5.66 and 78.63 ± 6.67 at 6th month after operation respectively, significantly higher than those before operation (58.88 ± 4.13 and 62.38 ± 2.00) (t=-8.632, t=-9.733, P<0.001 for all). Conclusion The arthriscopic debridement combined with proximal fibula osteotomy for treatment of knee osteoarthritis has the advantages of simple surgical procedure and less injury, and can significantly alleviate the pain, improve the knee function and obtain excellent short-term curative effect.