胫骨高位截骨术与腓骨截骨术治疗膝骨关节炎临床疗效比较

目的比较胫骨高位截骨术(HTO)与腓骨截骨术治疗膝关节骨性关节炎(KOA)临床疗效。 方法回顾性分析于2015年1月至2016年12月在佛山市中医院骨九科行HTO或腓骨截骨术治疗KOA的患者。HTO组共37例，男11例，女26例，平均年龄(59±3)岁；腓骨截骨组共26例，男9例，女17例，平均年龄(59±3)岁。分析比较两组的手术耗时、术中失血量、住院总花费、术后并发症、随访期内再次行膝关节置换情况。采用膝关节Lysholm评分、西安大略和曼彻斯特大学关节炎指数(WOMAC)对术前、术后6个月、术后12个月随访时膝关节功能进行评估。数据采用SPSS13.0统计学软件进行统计学分析。手术耗时、术中失血量、住院总花费、Lysholm评分、WOMAC评分均采用独立样本t检验，术后并发症、随访期内再次行膝关节置换情况比较采用卡方检验。 结果HTO组术后随访中位数15.7个月，腓骨截骨组术后随访中位数14.9个月。HTO组手术耗时(t＝21.094，P<0.05)、术中失血量(t＝9.91，P<0.05)、住院总花费(t＝65.471，P<0.05)均显著劣于腓骨截骨组。HTO组有1例(2.7%)并发症，腓骨截骨组有2例并发症(7.7%)，采用Fisher确切概率法分析，差异无统计学意义(P＝0.785)。两组患者术前膝关节Lysholm评分、WOMAC评分差异均无统计学意义。术后6个月Lysholm评分HTO组显著优于腓骨截骨组(t＝2.426，P<0.05)。WOMAC评分HTO组显著劣于腓骨截骨组(t＝3.997，P<0.01)。术后12个月HTO组Lysholm评分(t＝2.979，P<0.01)、WOMAC评分(t＝－2.472，P<0.05)均显著优于腓骨截骨组。 结论行胫骨高位截骨术治疗膝关节骨性关节炎比行腓骨截骨术手术耗时长、术中出血多、住院总花费多；术后12个月的随访提示行胫骨高位截骨术能比行腓骨截骨术取得更好的膝关节功能。

Comparison of high tibial osteotomy and fibula osteotomy in treatment of knee osteoarthritis

ObjectiveTo compare the clinical efficacy of high tibial osteotomy (HTO) and fibular osteotomy in the treatment of knee osteoarthritis (KOA). MethodsA retrospective analysis was made on the patients with KOA who underwent HTO or fibular osteotomy from January 2015 to December 2016 in the 9^th Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine. There were 37 cases in HTO group, 11 males and 26 females, with an average age of (59±3) 26 cases in fibular osteotomy group, nine males and 17 females, with an average age of (59±3). The operation time, intraoperative blood loss, total hospitalization cost, postoperative complications and knee arthroplasty were analyzed between the two groups. The Lysholm score and the University of Western Ontario and Manchester arthritis index (WOMAC) were used to assess the knee function before surgery, six months after surgery and 12 months after surgery. Data were analyzed by SPSS13.0 statistical software. The operation time, intraoperative blood loss, total cost of hospitalization, Lysholm score and WOMAC score were examined by independent sample t-test, and chi-square test was used to compare the incidence of postoperative knee arthroplasty and postoperative complications during follow-up period. ResultsThe median follow-up time of group HTO was 15.7 months, and the fibula osteotomy group had a median follow-up of 14.9 months. The operation time (t=21.094, P<0.05), intraoperative blood loss (t= 9.91, P<0.05), total hospitalization cost (t=65.471, P<0.05) in HTO group were significantly lower than those in fibular osteotomy group. There was one complication case in HTO group (2.7%) and two complication cases in fibular osteotomy group (7.7%) and no significant difference was found between the two groups by Fisher′s exact probability analysis (P=0.785). There was no significant difference in Lysholm score and WOMAC score between the two groups before operation. The Lysholm score in HTO group was significantly better than that in fibular osteotomy group (t=2.426, P<0.05). WOMAC score in HTO group was significantly lower than that in fibular osteotomy group (t=3.997, P<0.01). The Lysholm score (t=2.979, P<0.01), WOMAC score (t=-2.472, P<0.05) in HTO group were significantly better than those in fibular osteotomy group 12 months after operation. ConclusionHigh tibial osteotomy for osteoarthritis of the knee is more time-consuming, more bleeding and more hospital costs than fibular osteotomy; 12 months follow-up shows that high tibial osteotomy can achieve better knee function than fibular osteotomy.