关节镜辅助腓骨截骨治疗内侧间室膝骨关节炎疗效观察

目的探讨分析关节镜辅助腓骨截骨治疗膝内侧间室骨关节炎临床疗效。 方法自2016年7月至2017年7月间陕西省人民医院骨科收治15例膝内侧间室骨关节炎患者行腓骨截骨联合关节镜下清理术。纳入标准包括内侧膝关节痛，X线显示膝关节内侧间隙变窄；排除标准包括膝外翻或外侧间室病变、膝周韧带断裂等。其中男性4例，女性11例；平均年龄(65±13)岁。左膝7例，右膝11例。所有患者均内侧间室膝关节炎患者。采用重复测量的方差分析统计患者手术时间，平均住院日，手术前，术后2 d，术后3月膝关节内外间室高度比，视觉模拟评分法(VAS)、膝关节评分(HSS)和美国膝关节协会评分(KSS)。 结果平均住院日(8.5±1.6)d，单膝平均手术时间(51±16 )min。其中1例患者出现下肢肌间静脉血栓，治疗后好转。患者膝关节疼痛明显减轻，VAS评分由术前(6.42±1.54)分降为术后2 d(3.12±1.87)分，术后3月(2.04±0.65)分，差异有统计学意义(F ＝2.91，P <0.05)。HSS评分：术前(56.63±6.45)分，术后2 d(70.35±4.27)分，术后3月(79.16±5.25)分，差异有统计学意义(F ＝2.58，P <0.05)；KSS临床评分术前(62.28±9.15)分，术后2 d(68.36±11.50)分，术后3月(80.86±10.39)分，与术前及术后2 d相比，术后3月KSS临床评分有明显改善(F ＝3.04，P <0.05)；KSS功能评分术前(37.59±7.13)分，术后2 d(41.30±10.15)分，术后3月(70.54±4.91)分，与术前相比，术后2 d及术后3月KSS功能评分有改善(F ＝2.76，P <0.05)。术后2 d的X线显示内外侧间室高度比较术前明显增加(Z＝2.091，P <0.05)。 结论关节镜辅助腓骨截骨术对患者创伤小，并发症少，可有效缓解膝关节内侧间室骨关节炎患者的疼痛并改善关节功能，早期临床效果满意。

Evaluation of fibular osteotomy combining arthroscopic debridement in treatment of osteoarthritis in medial compartment of knee

ObjectiveTo evaluate early effect of proximal fibular osteotomy combined with arthroscopic debridement in the treatment of knee osteoarthritis(OA) with medial compartment. MethodsFrom July 2016 to July 2017, in Shaanxi Provincial People’s Hospital, 15 patients(18 knees) with medial compartment OA treated by proximal fibula osteotomy combined with arthroscopy debridement were analysed retrospectively. The inclusion criteria were pain in medial compartment of knee, X ray films showing medial compartment narrowing; the exclusion criteria were genu valgus, lateral compartment involvement and ligaments injury. Four males and 11 females with an average age of(65±13)years were enrolled.They were followed up at the 2^nd day and three months after the operation.The visual analogue scale (VAS), Hospital for Special Surgery (HSS) knee score, the American Knee Society score(KSS)and the corresponding radiographic between medial and lateral compartment assessment before and after operations were evaluated. ResultsAll 15 patients were available for a mean follow-up time of three months.The average operation duration was (50.6±15.7 )min, the average length of stay was (8.5±1.6 )d.At the final follow-up, three months after the operation mean VAS was(2.04±0.65), significantly lower than the preoperative one(F=2.91, P<0.05). Mean HSS knee score was(79.16±5.25), significantly higher than the preoperative score(56.63±6.45) (F=2.58, P<0.05). Clinical KSS knee score was(80.86±10.39), significantly higher than the mean preoperative score of (62.28±9.15) (F=3.04, P <0.05). Functional KSS knee score was(70.54±4.91), significantly higher than the mean preoperative score of (37.59±7.13) (F=2.76, P<0.05). X ray films of the weight-bearing knees were taken two days after the surgery, showing increased height of medial joint space compared with that before the operation(Z=2.091, P <0.05). ConclusionThe proximal fibula osteotomy combined with arthroscopic debridement for treatment of knee osteoarthritis has the advantages of simple surgical ptoeedure, less injury and can significantly reduce the pain, which can improve the knee function and obtain excellent early curative effect.