[1]黄永华,秦鸿飞,侯胜稳,等.膝关节镜清理术联合胫骨高位截骨术治疗内翻型膝骨关节炎的临床研究[J].中医正骨,2022,34(09):5-10.
　HUANG Yonghua,QIN Hongfei,HOU Shengwen,et al.A clinical study of knee arthroscopic debridement combined with high tibial osteotomy for treatment of varus knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(09):5-10.
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膝关节镜清理术联合胫骨高位截骨术治疗内翻型膝骨关节炎的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年09期
页码:
5-10
栏目:
临床研究
出版日期:
2022-09-20

文章信息/Info

Title:
A clinical study of knee arthroscopic debridement combined with high tibial osteotomy for treatment of varus knee osteoarthritis
作者:
黄永华; 秦鸿飞; 侯胜稳; 秦超
(南阳市中医院,河南南阳473007)
Author(s):
HUANG Yonghua; QIN Hongfei; HOU Shengwen; QIN Chao
Nanyang TCM Hospital,Nanyang 473007,Henan,China
关键词:
骨关节炎; 膝;  关节镜检查;  截骨术;  临床试验
Keywords:
osteoarthritis; knee;  arthroscopy;  osteotomy;  clinical trial
摘要:
目的:观察膝关节镜清理术联合胫骨高位截骨术(high tibial osteotomy,HTO)治疗内翻型膝骨关节炎的临床疗效和安全性。方法:回顾性分析80例内翻型膝骨关节炎患者的病例资料,其中采用膝关节镜清理术联合HTO治疗42例(联合手术组)、采用单纯HTO治疗38例(HTO组)。比较2组患者术前和术后1个月的Lysholm膝关节功能评分、膝部疼痛视觉模拟量表(visual analogue scale,VAS)评分、生活质量综合评定问卷-74(generic quality of life inventory-74,GQOL-74)评分以及术前和术后12个月的髋-膝-踝(hip-knee-ankle,HKA)角,并比较2组患者的膝关节软骨再生及并发症发生情况。结果:①Lysholm膝关节功能评分。术前和术后1个月,2组患者的Lysholm膝关节功能评分比较,组间差异均无统计学意义[(55.77±3.31)分,(57.23±3.31)分,t=1.970,P=0.084;(82.91±1.85)分,(82.74±2.91)分,t=0.315,P=0.832]; 术后1个月,2组患者的Lysholm膝关节功能评分均高于术前(t=46.385,P=0.000; t=35.680,P=0.000)。②膝部疼痛VAS评分。术前,2组患者的膝部疼痛VAS评分比较,差异无统计学意义[(7.22±1.31)分,(7.22±1.30)分,t=0.000,P=1.000]; 术后1个月,联合手术组患者的膝部疼痛VAS评分低于HTO组[(2.62±0.53)分,(4.11±0.71)分,t=10.701,P=0.000],2组患者的膝部疼痛VAS评分均低于术前(t=21.096,P=0.000; t=12.943,P=0.000)。③GQOL-74评分。术前,2组患者的GQOL-74评分比较,差异无统计学意义[(64.56±4.30)分,(65.11±4.13)分,t=0.582,P=0.564]; 术后1个月,联合手术组患者的GQOL-74评分高于HTO组[(85.37±3.25)分,(76.79±2.59)分,t=12.967,P=0.000],2组患者的GQOL-74评分均高于术前(t=25.021,P=0.000; t=14.770,P=0.000)。④HKA角。术前和术后12个月,2组患者的HKA角比较,组间差异均无统计学意义(171.31°±4.99°,172.28°±4.97°,t=0.870,P=0.268; 181.13°±1.58°,181.15°±1.61°,t=0.056,P=1.115); 术后12个月,2组患者的HKA角均大于术前(t=12.159,P=0.000; t=10.466,P=0.000)。⑤膝关节软骨再生情况。联合手术组膝关节软骨再生Ⅰ级1例,Ⅱ级41例,其中非成熟再生11例、成熟再生30例; HTO组膝关节软骨再生Ⅰ级4例,Ⅱ级34例,其中非成熟再生8例、成熟再生26例。2组患者膝关节软骨再生情况比较,差异无统计学意义(χ2=1.083,P=0.298)。⑥并发症发生情况。联合手术组1例出现关节腔积血; HTO组1例出现矫形角度丢失,2例出现骨赘增生,4例出现关节腔积血,1例出现足背麻木。联合手术组并发症发生率小于HTO组(χ2=5.222,P=0.022)。结论:采用膝关节镜清理术联合HTO治疗内翻型膝骨关节炎,与单纯的HTO比较,二者在改善膝关节功能、纠正下肢力线、促进膝关节软骨再生方面疗效相当,但前者较后者能更好地缓解膝关节疼痛、改善患者生活质量,且安全性更高。
Abstract:
Objective:To observe the clinical outcomes and safety of knee arthroscopic debridement combined with high tibial osteotomy(HTO)for treatment of varus knee osteoarthritis(KOA).Methods:The medical records of 80 patients with varus KOA were analyzed retrospectively.Forty-two patients were treated with knee arthroscopic debridement and HTO(combination therapy group),while the others with HTO alone(HTO group).The presurgical and postsurgical month-1 Lysholm knee function score,knee pain visual analogue scale(VAS)score,generic quality of life inventory-74(GQOL-74)score and the presurgical and postsurgical month-12 hip-knee-ankle(HKA)angle were compared between the 2 groups.Moreover,the knee cartilage regeneration and complication incidence were compared between the 2 groups.Results:①There was no statistical difference in presurgical and postsurgical month-1 Lysholm knee function scores between the 2 groups(55.77±3.31 vs 57.23±3.31 points,t=1.970,P=0.084; 82.91±1.85 vs 82.74±2.91 points,t=0.315,P=0.832).The Lysholm knee function scores increased at postsurgical month 1 compared to pre-surgery(t=46.385,P=0.000; t=35.680,P=0.000).②There was no statistical difference in presurgical knee pain VAS scores between the 2 groups(7.22±1.31 vs 7.22±1.30 points,t=0.000,P=1.000).The postsurgical month-1 knee pain VAS scores were lower in combination therapy group compared to HTO group(2.62±0.53 vs 4.11±0.71 points,t=10.701,P=0.000),and the knee pain VAS scores decreased in the 2 groups at postsurgical month 1 compared to pre-surgery(t=21.096,P=0.000; t=12.943,P=0.000).③There was no statistical difference in presurgical GQOL-74 scores between the 2 groups(64.56±4.30 vs 65.11±4.13 points,t=0.582,P=0.564).The postsurgical month-1 GQOL-74 scores were higher in combination therapy group compared to HTO group(85.37±3.25 vs 76.79±2.59 points,t=12.967,P=0.000),and the GQOL-74 scores increased in the 2 groups at postsurgical month 1 compared to pre-surgery(t=25.021,P=0.000; t=14.770,P=0.000).④There was no statistical difference in presurgical and postsurgical month-12 HKA angle between the 2 groups(171.31±4.99 vs 172.28±4.97 degrees,t=0.870,P=0.268; 181.13±1.58 vs 181.15±1.61 degrees,t=0.056,P=1.115).The HKA angles increased at postsurgical month 12 compared to pre-surgery(t=12.159,P=0.000; t=10.466,P=0.000).⑤The knee cartilage regeneration belonged to gradeⅠin 1 patient and gradeⅡin 41 patients in combination therapy group,including immature regeneration in 11 patients and mature regeneration in 30 patients; while the knee cartilage regeneration belonged to gradeⅠin 4 patients and gradeⅡin 34 patients in HTO group,including immature regeneration in 8 patients and mature regeneration in 26 patients.There was no statistical difference in knee cartilage regeneration between the 2 groups(χ2=1.083,P=0.298).⑥The articular cavity hematocele(1 case)was found in combination therapy group; while the loss of orthopaedic angle(1 case),osteophyte hyperplasia(2 cases),articular cavity hematocele(4 cases)and foot dorsum numbness(1 case)were found in HTO group.The complication incidence rate was lower in combination therapy group compared to HTO group(χ2=5.222,P=0.022).Conclusion:The knee arthroscopic debridement combined with HTO is similar to HTO alone for improving knee function,correcting lower limb force-line and promoting knee cartilage regeneration in treatment of varus KOA; while the former can better relieve knee pain,improve patient's life quality with high safety compared to the latter.

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备注/Memo

备注/Memo:
基金项目:河南省中医药科学研究专项课题(20-21ZY2300) 通讯作者:黄永华 E-mail:nyszyyhyh@163.com
更新日期/Last Update: 1900-01-01