关节镜联合胫骨高位截骨治疗伴膝内翻的中老年患者内侧半月板退变性损伤

目的探讨关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤的早期疗效。 方法回顾性分析2014年1月至2015年1月，西南医科大学附属医院骨关节外科收治的伴膝内翻的内侧半月板退变性损伤患者26例，采取关节镜联合胫骨高位截骨的手术方式进行治疗。其中男性18例（18膝），女性8例（8膝）：年龄43~58岁，平均（49±6）岁。所有患者均为内侧半月板退变性损伤且伴有膝内翻，均行内侧撑开胫骨高位截骨，关节镜下半月板部分切除术缓解疼痛。测量下肢机械轴通过胫骨平台的相对位置、股胫角、胫骨平台后倾角；末次随访时评估膝关节各间室骨关节炎进展情况，采用Lysholm评分、美国特种外科医院（HSS）评分和Tegner膝关节运动评分评价膝关节功能，采用视觉模拟疼痛评分（VAS）评价疗效。 结果本组26例患者均获随访，随访时间为1.0~2.8年，平均为（1.6±0.5）年。未发现感染、下肢深静脉血栓形成、骨不愈合或延迟愈合等并发症。下肢机械轴通过胫骨平台的相对位置由术前（21.2±3.8）%改善至（59.5±1.7）%，股胫角由术前的（172±4）°改善至（179±4）°，差异均有统计学意义（t=14.257，P<0.05；t=10.572，P<0.05）。术前胫骨平台后倾角为（7.5±2.2）°，术后为（7.9±1.9）°，差异无统计学意义（t=1.628，P>0.05）。末次随访时，患者Lysholm评分、HSS评分、Tegner评分、VAS评分均较术前明显改善，差异有统计学意义（t=7.684，P<0.05；t=16.521，P<0.05；t=6.284，P<0.05；t=12.359，P<0.05）。 结论关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤，能够有效改善下肢力线和缓解关节疼痛，早期临床疗效满意。

Arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint in the middle aged patient

Objective To explore the short-term effectiveness of arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint.Methods A retrospective study was performed on 26 patients with degenerative tears of the medial meniscus with varus deformity of knee joint who underwent arthroscopic combined with high tibial osteotomy that received in the Affiliated Hospital of Southwest Medical University from January 2014 to January 2015.There were 18 males(18 knees)and 8 females(8 knees),aged 43-58 years(mean,49±6 years).All the patients were degenerative tears of the medial meniscus combined with varus deformity of knee joint.All patients underwent high tibial osteotomy,and the partial menisectomy was adjusted to relieve pain.Evaluated the position of weight bearing line,femoral tibial angle and posterior tibial slope.The Lysholm scores,Hospital for Special Surgery(HSS)score,and Tegner knee activity(Tegner)score were used to estimate knee joint function,while the visual analogue scale(VAS)scores were used to estimate the efficacy.Results Twenty-six patients in this group were all followed up,and the follow up time was 1.0-2.8 years,average(1.6±0.5)years.No complications of infection,deep vein thrombosis,nonunion or delayed union was observed.The weight bearing line was corrected from(21.3±3.8)%preoperatively to(59.5±1.7)%postoperatively.The femoraltibial angle was(172±4)°preoperatively and improved to(179±4)°postoperatively,and the differences were all statistically significant(t=14.257,P<0.05;t=10.572,P<0.05).The tibial slope was increased from(7.5±2.2)°preoperatively to(7.9±1.9)°postoperatively,showing no significant differences(t=1.628,P>0.05).At last follow-up,Lysholm score,HSS score,Tegner score,and VAS were significantly improved than preoperative ones,showing significant differences(t=7.684,P<0.05;t=16.521,P<0.05;t=6.284,P<0.05;t=12.359,P<0.05).Conclusion Arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint can significantly improve the alignment of lower extremity and relieve pain,and can get a good short term efficacy.