关节镜联合开放楔形胫骨高位截骨术治疗膝关节骨关节炎的早期效果

目的 分析关节镜结合胫骨高位截骨术((high tibial osteotomy, HTO)治疗膝关节骨关节炎的早期效果。方法　选取2018年6月至2019年6月绵阳市中心医院骨科收治的因膝关节骨关节炎接受关节镜联合胫骨高位截骨术的患者88例(88膝)患者。收集评价患者美国特种外科医院膝关节评分(hospital for special surgery knee score, HSS)、视觉模拟评分(visual analogue scale,VAS)、手术前后下肢全长下X线片胫股角(femorotibial angle, FTA)、胫骨近端内侧角(medial proximal tibial angle, MPTA)等指标,并进行分析。结果　全部患者均得到随访,随访时间6~18月,平均12月。患者HSS评分术前(57.46±4.87)分、术后(79.19±2.48)分、术后1月(81.52±3.97)分逐渐增加,VAS评分术前(4.03±0.82)分、术后(2.52±0.50)分、术后1月(1.00±0.81)分逐渐降低,差异有统计学意义(P＜0.05)。FTA术前(179.72±2.30)°纠正至术后(172.81±1.36)°, MPTA术前(83.35±1.61)°纠正至术后(88.47±7.16)°,差异有统计学意义(P＜0.05)。结论　关节镜联合胫骨高位截骨术治疗膝关节骨关节炎早期在下肢力线及疼痛改善方面能取得较为满意效果。但其膝关节软骨恢复情况等需要进一步长期随访研究。

Early results of arthroscopy combined with open-wedge high tibial osteotomy in the treatment of knee osteoarthritis

Objective To analyze the early effect of high tibial osteotomy (HTO) combined with arthroscopy in the treatment of osteoarthritis of the knee. Methods 88 patients (88 knees) admitted to the department of orthopedics of Mianyang central hospital from June 2018 to June 2019 who underwent arthroscopy combined with high tibial osteotomy for osteoarthritis of the knee were selected. Indexes such as hospital for special surgery knee score (HSS), visual analogue scale (VAS), femorotibial Angle (FTA) and medial proximal tibial Angle (MPTA) were collected and evaluated before and after surgery. Results All patients were followed up for 6 to 18 months, with an average of 12 months.HSS score of the patients increased gradually before surgery (57.46±4.87) points, after surgery (79.19±2.48) points, 1 month after surgery (81.52±3.97) points, VAS score decreased gradually before surgery (4.03±0.82) points, after surgery (2.52±0.50) points, 1 month after surgery (1.00±0.81) points, the difference was statistically significant (P < 0.05).Before FTA (179.72±2.30)° was corrected to postoperative (172.81±1.36)°; before MPTA (83.35±1.61)° was corrected to postoperative (88.47±7.16)°, the difference was statistically significant (P < 0.05).Conclusion Arthroscopy combined with high tibial osteotomy in the early treatment of knee osteoarthritis can achieve satisfactory results in the improvement of lower limb alignment and pain. However, the recovery of knee cartilage needs further long-term follow-up study.