胫骨高位截骨联合外侧支持带松解治疗内翻型膝骨性关节炎合并髌骨外侧高压综合征

目的:探讨胫骨高位截骨术联合关节镜下髌骨外侧支持带松解术在内翻型膝骨性关节炎膝关节屈曲功能的临床疗效。方法:对2017年10月至2019年4月采用胫骨高位截骨联合关节镜下髌骨外侧支持带松解治疗的43例内翻型膝关节骨性关节炎合并髌骨外侧高压综合征患者进行回顾性分析,其中男15例,女28例;年龄53~72(62.05±5.17)岁。分别于术前,术后2周,3和12个月采用疼痛视觉模拟评分(visual analogue scale,VAS),Lysholm评分及膝关节主动屈曲活动度评定膝关节疼痛,功能改善情况,并于术前与术后12个月测量髌股吻合角(congruence angle,CA),髌骨倾斜角(patellar tilt angle,PTA)及股胫角(femora-tibial angle,FTA)评价髌股关节的对合与下肢力线的改善情况。结果:43例患者均获得随访,时间14~28(19.60±4.50)个月。VAS评分由术前的6.65±0.65降至术后2周、3和12个月的2.16±0.95、0.51±0.77、0.33±0.64,各时间点比较差异有统计学意义(P<0.001)。Lysholm评分由术前的43.02±8.54增至术后2周,3、12个月的46.84±2.81、72.42±5.30、93.40±5.44,差异有统计学意义(P<0.001)。膝关节主动屈曲活动度由术前的(86.97±5.02)°增至术后2周,3、12个月的(99.38±3.27)°、(110.13±4.13)°、(113.03±4.85)°,各时间点比较差异有统计学意义(P<0.001)。CA由术前的(7.81±1.21)°降至术后12个月的(5.82±4.10)°;PTA由术前的(15.87±2.89)°降至术后12个月的(13.79±4.26)°;FTA由术前的(182.61±2.07)°降至术后12个月的(170.89±0.89)°,差异有统计学意义(P<0.05)。1例术后小腿肌间静脉血栓,予适当制动、抗凝,1周后复查消失;14例术后肿胀,2周后肿胀消退。结论:胫骨高位截骨联合关节镜下髌骨外侧支持带松解治疗内翻型膝骨性关节炎即可缓解膝关节冠状位负重疼痛,又能改善矢状位膝关节屈曲功能。

High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome

Objective: To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.Methods: From October 2017 to April 2019,a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females,aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS),Lysholm,and the knee range of motion were used to evaluate knee pain and functional recovery before operation,2 weeks,3 months and 12 months after operation. And the congruence angle (CA),patellar tilt angle (PTA),and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint,and the improvement of line of gravity of lower limb.Results: All 43 patients were followed up for more than 12 months,with a follow-up time of 14 to 28(19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95,0.51±0.77 and 0.33±0.64 at 2 weeks,3 months and 12 months after operation,and the difference was statistically significant (P<0.001). Lysholm score increased from 43.02±8.54 before operation to 46.84±2.81,72.42±5.30,and 93.40±5.44 at 2 weeks,3 months and 12 months after operation,and the difference was statistically significant(P<0.001). The knee range of motion increased from(86.97±5.02)° before operation to(99.38±3.27)°,(110.13±4.13)°,and (113.03±4.85)° at 2 weeks,3 months and 12 months after operation,the difference was statistically significant(P<0.001). The CA decreased from(7.81±1.21)° before operation to(5.82±4.10)° at 12 months after operation,the PTA decreased from (15.87±2.89)° before operation to(13.79±4.26)° at 12 months after operation,and the FTA decreased from(182.61±2.07)° before operation to(170.89±0.89)° at 12 months after operation,and the differences were statistically significant(P<0.05). One case received proper braking and anticoagulation after operation,and was improved after 1 week. The swelling was observed in 14 patients after operation,and subsided about 2 weeks later.Conclusion: High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.