胫骨髁外翻截骨术治疗创伤性膝关节炎的早期临床疗效分析

目的 探讨胫骨髁外翻截骨术（TCVO）治疗陈旧性内侧胫骨平台骨折并发创伤性膝关节炎（TKOA）的早期临床疗效。方法 回顾性分析2016年6月至2021年6月于苏州市立医院关节外科接受TCVO手术治疗陈旧性内侧胫骨平台骨折并发TKOA的18例患者的术前及术后相关临床资料，所有患膝均为陈旧性内侧胫骨平台骨折保守治疗后畸形愈合并发膝内翻TKOA。患者发生胫骨平台骨折至TCVO手术治疗的时间为49 ～ 171个月，平均（111.1±33.8）个月；患膝内翻角度为6.81° ～ 14.49°，平均10.95°±2.62°；关节线会聚角（JLCA）为3.58° ～ 8.12°，平均5.95°±1.42°。所有患者于术前及术后3个月拍摄站立位双下肢全长X线片、膝关节正侧位X线片并测量患膝内翻角度、胫骨近端内侧角（MPTA）、JLCA、胫骨平台后倾角（PTS），评估术前、术后下肢力线以及膝关节对合状态的变化情况。依据术前及术后3、12个月的患膝关节活动度（ROM）、疼痛视觉模拟评分（VAS）、西安大略与麦克马斯特大学（WOMAC）骨关节炎指数、膝关节损伤与骨关节炎评分（KOOS）评估早期临床疗效。结果 18例患者均获得随访，随访时间为14 ～ 65个月，平均随访（27.4±14.4）个月。术后3个月时，患膝内翻角、JLCA均较术前显著降低，差异均具有统计学意义（P＜0.05）；MPTA与术前相比有显著提升，差异有统计学意义（P＜0.05）；PTS与术前相比差异无统计学意义（P＞0.05）。术后3、12个月时，患膝关节ROM、VAS、WOMAC、KOOS评分均较术前有显著好转，差异均具有统计学意义（P＜0.05）。结论 采用TCVO治疗陈旧性内侧胫骨平台骨折并发TKOA可以取得良好的早期临床疗效，有效矫正膝关节内翻畸形，缓解膝关节疼痛及改善膝关节功能。

Early clinical efficacy analysis of tibial condylar valgus osteotomy for traumatic knee osteoarthritis

Objective To evaluate the early clinical efficacy of tibial condylar valgus osteotomy (TCVO) in the treatment of traumatic knee osteoarthritis (TKOA) caused by old medial tibial plateau fractures.Methods A total of 18 patients who underwent TCVO surgery for the treatment of TKOA caused by old medial tibial plateau fractures in the department of joint surgery, Suzhou Municipal Hospital from June 2016 to June 2021, were included in this retrospective study. All the affected knees were genu varum complicated with TKOA caused by malunion after conservative treatment of old medial tibial plateau fractures. The time from fracture to TCVO surgery was 111.1±33.8 (49-171) months, and the varus angle was 10.95°±2.62° (6.81°-14.49°), and the joint line convergence angle (JLCA) was 5.95°±1.42° (3.58°-8.12°). The varus angle, medial proximal tibial angle (MPTA), JLCA, and posterior tibial slope (PTS) of the affected knee were measured to evaluate the changes in the alignment and congruency of the knee joint between before and after surgery, based on full-length standing radiographs of both lower limbs taken before and 3 months after surgery. Range of motion (ROM) of the affected knee, visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used before and 3 months, 12 months after surgery to evaluate early clinical efficacy.Results The follow-up time of the 18 patients was 14-65 months, with an average of (27.4±14.4) months. At 3 months postoperatively, the varus angle and JLCA of the affected knee were significantly decreased compared with those before surgery (P<0.05). MPTA was significantly increased compared to preoperative values (P<0.05). However, there was no significant difference for PTS between before and 3 months after surgery (P>0.05). At 3 and 12 months after surgery, the ROM, VAS, WOMAC and KOOS scores were significantly improved compared with those before surgery, all with statistical significance(P<0.05).Conclusion In the treatment of TKOA caused by old medial tibial plateau fractures, TCVO can achieve good early clinical efficacy, and effectively correct knee varus deformity, relieve knee joint pain and improve knee joint function.