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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

35

期数:

2018年5

页码:

411-414

栏目:

临床研究

出版日期:

2018-05-05

文章信息/Info

Title:

Effect of high tibial osteotomy combined with arthroscopic debridement in the treatment of medial compartmental osteoarthritis of the knee joint

作者:

赵自彪¹; 王　博¹; 段军富¹; 李云靖¹; 付军振¹; 张红敏²

（1.鹤壁市人民医院骨一科，河南　鹤壁　458030；2.鹤壁市淇滨区人民检察院，河南　鹤壁　458030）

Author(s):

ZHAO Zi-biao¹; WANG Bo¹; DUAN Jun-fu¹; LI Yun-jing¹; FU Jun-zhen¹; ZHANG Hong-min²

（1.Department of Osteology，the People′s Hospital of Hebi City，Hebi 458030，Henan Province，China；2.The People′s Procuratorate of Qibin District of Hebi City，Hebi 458030，Henan Province，China）

关键词:

膝骨性关节炎; 胫骨高位截骨术; 关节镜下清理术; Tomofix锁定钢板

Keywords:

osteoarthritis of the knee; high tibial osteotomy; arthroscopic debridement; Tomofix locking plate

分类号:

R687.4

DOI:

10.7683/xxyxyxb.2018.05.014

文献标志码:

A

摘要:

目的　探讨胫骨高位截骨术（HTO）联合关节镜下清理术治疗膝关节内侧单间室骨性关节炎的临床效果。方法　选择2015年5月至2017年11月鹤壁市人民医院收治的膝关节内侧单间室骨性关节炎患者18例（共18膝），所有患者施行HTO、关节镜下清理、Tomofix锁定钢板内固定术，记录患者手术时间、截骨厚度及截骨愈合时间，分别于术前及术后1 a进行膝关节X线片检查，测量股胫角、下肢机械轴通过胫骨平台的相对位置、髁间窝指数及胫骨平台后倾角，测量伸膝受限角度，并进行膝关节Lysholm评分和疼痛视觉模拟评分法（VAS）评分，评估治疗效果。结果　18例患者的手术时间为1.4～2.2（1.68±0.34）h，截骨厚度为14～19（15.49±2.72）mm，截骨愈合时间为3～8（3.42±0.41）个月。术前患者股胫角、下肢机械轴经胫骨平台的相对位置、髁间窝指数及胫骨平台后倾角分别为（182.17±1.23）°、（17.38±5.05）%、0.220±0.006、（7.79±2.05）°，术后1 a时分别为（169.72±1.42）°、（59.08±3.23）%、0.274±0.008、（7.84±1.87）°；术后1 a患者股胫角显著小于术前，机械轴经胫骨平台的相对位置和髁间窝指数显著大于术前（P<0.05）；但术前与术后1 a时胫骨平台后倾角比较差异无统计学意义（P>0.05）。术前患者膝关节屈曲畸形角度、Lysholm评分及疼痛VAS评分分别为（11.12±3.08）°、50.68±6.46、6.51±1.26，术后1 a时分别为（1.38±1.35）°、75.69±7.38、2.49±0.94；术后1 a患者膝关节屈曲畸形角度和疼痛VAS评分显著低于术前，Lysholm评分显著高于术前（P<0.05）。18例患者术中和术后均未发生严重并发症。结论　HTO联合关节镜下清理术治疗膝关节内侧单间室骨性关节炎可显著矫正膝关节畸形，改善膝关节功能，减轻膝关节疼痛，疗效肯定。

Abstract:

Objective　To investigate the effect of high tibial osteotomy（HTO） combined with arthroscopic debridement in the treatment of medial compartmental osteoarthritis of the knee joint.Methods　Eighteen patients（eighteen knee joints） with medial compartmental osteoarthritis of the knee joint were selected from May 2015 to November 2017 in the People′s Hospital of Hebi City.All patients were treated with HTO，arthroscopic debridement and Tomofix locking plate internal fixation.The operation time，the thickness of osteotomy and the bone healing time were recorded.The femoral tibial angle，relative position of lower limb mechanical axis through the tibial plateau，the index of intercondylar fossa and the posterior slope angle of tibial plateau were measured by X-ray films before and one year after operation.The knee extension angle was measured.The Lysholm score and the visual analogue scale （VAS） score of the pain of the knee joint were performed，and the therapeutic effect was evaluated.Results　The operation time，the thickness of osteotomy and the bone healing time of the 18 patients were 1.4-2.2 （1.68±0.34） h，14-19 （15.49±2.72） mm and 3-8 （3.42±0.41） months.The femoral tibial angle，relative position of lower limb mechanical axis through the tibial plateau，the index of intercondylar fossa and the posterior slope angle of tibial plateau were （182.17±1.23）°，（17.38±5.05）%，0.220±0.006 and （7.79±2.05）° before operation；and they were （169.72±1.42）°，（59.08±3.23）%，0.274±0.008 and （7.84±1.87）° at one year after operation.Compared with before operation，the femoral tibial angle was significantly less，and the relative position of lower limb mechanical axis through the tibial plateau and the index of intercondylar fossa were significantly more at one year after operation（P<0.05）.There was no significant difference in the posterior slope angle of tibial plateau before and one year after operation（P>0.05）.The knee flexion deformity angle，Lysholm score and VAS score were （11.12±3.08），50.68±6.46 and 6.51±1.26 respectively before operation；and they were （1.38±1.35）°，75.69±7.38 and 2.49±0.94 respectively after one year；compared with before operation，the knee flexion deformity angle and VAS score were significantly decreased，and the Lysholm score was significantly higher after one year（P<0.05）.There was no severe intraoperative and postoperative complication in the 18 patients.Conclusion　HTO combined with arthroscopic debridement for the treatment of medial compartmental osteoarthritis of the knee joint is effective in correcting genual malformation，improving knee joint function and relieving knee joint pain.

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更新日期/Last Update: 2018-05-05