胫骨高位截骨术治疗膝关节骨性关节炎随访10年的临床观察

目的:探讨外侧闭合胫骨高位截骨术治疗随访10年膝关节骨性关节炎患者的长期临床疗效。方法 :自2005年6月至2015年12月,采用外侧闭合胫骨高位截骨螺钉钢丝内固定术治疗20例膝关节内侧间室骨性关节炎患者,男3例,女17例,年龄43～76(57.80±8.05)岁。分别在术前,术后1、5、10年采用疼痛视觉模拟评分(VAS)和美国膝关节协会评分(KSS)评价膝关节疼痛、功能恢复情况,并观察术后并发症情况。结果:20例患者中16例获得随访,4例失访,随访时间9～11(10.0±0.8)年。VAS评分由术前的7.88±1.15降至术后1、5、10年的3.19±0.91、3.44±0.96、3.69±1.20,术后各时间点与术前比较差异有统计学意义(P0.05)。KSS临床评分由术前的61.94±5.74增加至术后1、5、10年的75.50±4.62、80.13±3.97、77.38±6.40,术后各时间点与术前比较差异有统计学意义(P0.05)。KSS功能评分由术前的62.81±13.03增加至术后1、5、10年的77.50±8.56、81.88±6.55、76.88±10.78,术后各时间点与术前比较差异有统计学意义(P0.05)。所有患者术后伤口愈合良好,无腓总神经损伤及截骨不愈合的并发症。结论:外侧闭合胫骨高位截骨螺钉钢丝内固定术治疗膝关节骨关节炎具有较好效果,可以阻止或延缓膝关节骨性关节炎进展,长期随访能达到与关节置换相当的效果。

Clinical observation of high tibial osteotomy for knee osteoarthritis: 10 years follow-up

Objective:To explore long-term following-up clinical effects of lateral closed high tibial osteotomy for the treatment of knee osteoarthritis.

Methods:Twenty patients with medial unicompartmental knee osteoarthritis were treated with lateral closed high tibial osteotomy and screw fixation from June 2005 to December 2015. Among them,including 17 females and 3 males,aged from 43 to 76 years old with an average of (57.80±8.05) years old. VAS score and KSS score were applied to evaluate recovery degree of pain and function before operation and after operation at 1,5 and 10 years,and postoperative complications were observed.

Results:Sixteen patients were followed-up,the time ranged from 9 to 11(10.0±0.8) years,4 patients were loss to follow-up. Preoperative VAS score was 7.88±1.15 and decreased to 3.19±0.91,3.44±0.96,3.69±1.20 at 1,5 and 10 years after operation,and there were statistical differences in VAS score between before and after operation at different time points (P<0.05). Clinical score of KSS increased from 61.94±5.74 before opertaion to 75.50±4.62,80.13±3.97,77.38±6.40 at 1,5 and 10 years after operation,and there were statistical differences in clinical score of KSS between before and after operation at different time points(P<0.05);functional score of KSS increased from 62.81±13.03 before operation to 77.50±8.56,81.88±6.55,76.88±10.78,and there were statistical differences in functional score of KSS between before and after operation at different time points(P<0.05). All incisions healed well without complications such as fibula nerve injury and fracture nonunion.

Conclusion:Lateral closed high tibial osteotomy and screw fixation for knee osteoarthritis could receive good clinical results,stop and delay progress of knee osteoarthritis,and long-term following-up could achieve the same effect as total knee arthroplasty.