腓骨近端截骨治疗高龄高危膝关节骨性关节炎的疗效分析

目的探讨腓骨近端截骨治疗高龄、高危膝关节骨性关节炎患者的近期疗效。 方法自2015年4月1日至2018年1月31日，淄博市第七人民医院骨科共收治以膝关节内侧间隙疼痛为主要表现的患者45例（共48膝），其中女性33例（73%），男性12例（27%），平均年龄（78±3）岁。均采用腓骨近端截骨术对其膝关节骨性关节炎进行治疗。记录住院天数、手术时间、术中出血、术后并发症，于术前、术后2 d、3个月、6个月对患者进行VAS、KSS评分，手术前后进行相应影像学评估，测量膝关节内外间室高度变化情况。 结果患者住院天数平均为（4.0±2.4）d；单侧手术时间平均为（33±8）min，术中出血平均为（20±8）ml。术后均未出现伤口感染、延迟愈合及神经损伤等并发症。与术前相比，术后2 d、3个月、6个月的VAS评分均降低（F=93.248，P<0.05）、KSS临床评分升高（F=68.621，P<0.05）、KSS功能评分升高（F=56.362，P<0.05），差异具有统计学意义。至末次随访时，45例（48膝）患者胫骨平台内翻角由术前的（83.2±2.1）°增至术后的（84.0±2.3）°，差异具有统计学意义（t=-2.110，P<0.05）；膝关节外侧间室高度由术前的（0.75±0.10）cm降至术后的（0.68±0.115）cm，差异具有统计学意义（t=5.473，P<0.05）。 结论腓骨近端截骨术是治疗高龄高危患者内翻型膝关节骨性关节炎的有效方法。

Analysis of proximal fibular osteotomy for the treatment of senile high-risk knee osteoarthritis

ObjectiveTo investigate the value of proximal fibular osteotomy in the preliminary clinical efficacy of senile and high-risk knee osteoarthritis. MethodsData of fourty-five patients (fourty-eight knees) with knee osteoarthritis with inner lateral chambers pain as the main manifestation were admitted and treated from April1 2015 to January 31 2018. The average age is 78±3 years. All patients were underwent proximal fibular osteotomy. The hospitalization days, operating time, blood loss, postoperative complications and VAS, KSS knee score were recorded at preoperative 2 days, 3 months and 6 months after operation. The value of radiographic assessment and change of height of the inner and outer chambers of the knee were compared. ResultsThe hospital stay days was (4.0±2.4) d, the unilateral operation time was (33.3±8.4) mins and the intraoperative blood loss during the operation was (20±8) ml. No complications such as wound infection, delayed healing and nerve injury occurred after operation. Compared with preoperative, VAS scores were decreased at 2 d, 3 and 6 months after surgery (F=93.248, P<0.05), and KSS clinical scores were increased (F=68.621, P<0.05), KSS function. The score was increased (F=56.362, P<0.05), and the difference was statistically significant. At the last follow-up, 45 patients (48 knees) had an increased patellofemoral angle from 83.2±2.1° to 84.0±2.3° (t=-2.110, P<0.05); the height of the lateral space of the knee joint was reduced from 0.75±0.10 cm to 0.68±0.115 cm before operation (t=5.473, P<0.05). ConclusionsProximal humerus osteotomy is an effective method for the treatment of varus knee osteoarthritis in high-risk patients.