胫骨高位截骨术联合关节镜治疗老年内侧间室膝骨关节炎

目的:探讨胫骨高位截骨术联合关节镜治疗老年内侧间室膝骨关节炎患者的近期临床疗效。方法 :回顾性分析2017年8月至2018年10月行胫骨高位截骨术联合关节镜治疗的老年内侧间室膝骨关节炎患者61例,其中男17例,女44例;年龄60～83(67.87±6.45)岁。术前及术后12个月采用下肢力线比率(weight bearing line,WBL),股胫角(femora-tibial angle,FTA)评估下肢力线情况;术前及术后1、3、12个月采用视觉模拟疼痛(visual analogue scale,VAS)评分,美国特种外科医院(Hospital for Special Surgery,HSS)评分评估膝关节功能恢复情况。结果:61例患者均获得随访,时间12～19(14.27±4.69)个月;下肢力线比率由术前的(14.79±5.61)%提高至术后12个月的(59.33±7.82)%,差异有统计学意义(t=2.294,P0.05);股胫角由术前的(182.14±2.19)°提高至术后12个月的(171.54±3.16)°,差异有统计学意义(t=1.827,P0.05)。VAS评分由术前的6.14±2.21分别降至术后1、3、12个月的3.64±0.92、2.02±0.63、0.93±0.61,差异有统计学意义(F=458.24,P0.001);HSS评分由术前的49.66±13.79分别提高至术后1、3、12个月的58.39±9.26、71.82±6.06、82.71±6.97,差异有统计学意义(F=266.45,P0.001)。3例患者术中出现对侧骨皮质断裂,调整力线后固定,术后12个月截骨区愈合良好;4例手术切口愈合缓慢,分别在术后3～4周愈合。结论:胫骨高位截骨术联合关节镜可以有效调整老年内侧间室膝骨关节炎患者的下肢力线,改善膝关节疼痛及功能障碍。

High tibial osteotomy combined with arthroscopy for elderly patients with knee osteoarthritis of medial compartment

Objective: To observe early clinical effect of high tibial osteotomy combined with arthroscopy for elderly patients with knee osteoarthritis of medial compartment.Methods: Sixty-one elderly patients with medial compartment knee osteoarthritis were treated with high tibial osteotomy combined with arthroscopy from August 2017 to October 2018. Among them,including 17 males and 44 females,aged from 60 to 83 years old with an average of (67.87±6.45) years old. Weight bearing line(WBL) and femora-tibial angle(FTA) were analyzed to assess lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) score and Hospital for Special Surgery (HSS) score were used to evaluate knee pain and function before and 1,3,12 months after surgery.Results: All patients were followed up from 12 to 19 months with an average of (14.27±4.69) months. WBL was improved from (14.79±5.61)% before operation to (59.33±7.82)% at 12 months after operation (t=2.294,P<0.05),FTA was improved from (182.14±2.19)° before operation to (171.54±3.16)° at 12 months after operation(t=1.827,P<0.05). VAS score decreased from 6.14±2.21 before operation to 3.64±0.92,2.02±0.63 and 0.93±0.61 at 1,3 and 12 months after operation(F=458.24,P<0.001),HSS score increased from 49.66±13.79 to 58.39±9.26,71.82±6.06 and 82.71±6.97 at 1,3 and 12 months after operation(F=266.45,P<0.001). Three patients had contralateral cortical fracture during surgery,whose osteotomy area healed well at 12 months after surgery. The incision healing of 4 cases was slow,while all healed at 3 to 4 weeks after surgery.Conclusion: High tibial osteotomy combined with arthroscopy could adjust lower limb alignment effectively,relieve knee pain and functional dysfunction,which indicated a significant short-term efficacy on the elderly patients with knee osteoarthritis of medial compartment.