腓骨高位截骨在膝关节骨性关节炎的应用

目的:探讨腓骨高位截骨术对膝关节骨性关节炎的短中期疗效。方法:2014年10月至2016年7月,采用腓骨高位截骨治疗膝关节骨性关节炎76例,男22例,女54例;年龄47~82岁,平均61.62岁。术前查体膝关节内侧压痛,内侧麦氏征阳性,摄膝关节负重正侧位X线片显示内侧间隙变窄,术后行膝内侧间隙、股骨胫骨角、VAS疼痛评分及AKS评分进行评价。结果:术后随访10~18个月,平均8.9个月。与术前相比,术后膝内侧间隙明显变宽,股骨胫骨角度变大。术前VAS疼痛评分5.70±1.56,术后1周3.70±1.03,1个月3.20±0.95,3个月2.35±0.99,1年2.10±0.97。膝关节功能AKS评分术前疼痛14.45±1.76,活动度12.60±1.98,稳定性12.15±1.72;末次随访疼痛42.60±2.28,活动度21.80±2.14,稳定性20.85±2.16。VAS评分术前与术后各时间段相比差异有统计学意义,AKS评分术前与术后差异均有统计学意义。结论:腓骨高位截骨操作简单,并发症少,能有效减轻膝关节疼痛,改善膝关节功能,临床效果满意。

Application of high fibular osteotomy in the treatment of knee osteoarthritis

Objective: To evaluate the short and mid term curative effect of high fibular osteotomy on knee osteoarthritis.Methods: From October 2014 to July 2016,76 patients with knee osteoarthritis were treated with high fibular osteotomy. There were 22 males and 54 females,ranging in age from 47 to 82 years old,with an average of 61.62 years old. Internal tenderness of the knee joint was examined preoperatively. Preoperative examination showed medial knee pain and medial positive McMurray sign. Preoperative AP and lateral X-ray films of the weight-bearing side of the knee showed the narrowing of the medial space. The knee medial space,femoral and tibial angle,VAS pain score and the American Knee Society(AKS) score were evaluated after operation.Results: Compared with the preoperative one,the postoperative knee medial gap was widened obviously. The femur and tibia angle after operation was bigger than that before surgery. The VAS was improved from preoperative 5.70±1.56,to 3.70±1.03 at the 1st week after operation,3.20±0.95 at the 1st month after operation,2.35±0.99 at the 3rd month after operation,and 2.10±0.97 at the 1st year after operation. According to the AKS score,the preoperative pain score of knee joint was 14.45±1.76,the activity score of knee joint was 12.60±1.98,and the stability score was 12.15±1.72; after operation,the above scores were improved to 42.60±2.28,21.80±2.14,and 20.85±2.16 respectively.Conclusion: The high fibular osteotomy with less complications is simple. It can effectively alleviate the pain of the knee joint and improve the function of knee joint,and the clinical effect is satisfactory.