[1]李晓敏,田向东,谭冶彤,等.胫骨结节远端单平面截骨治疗合并骨质疏松症的老年膝骨关节炎[J].中医正骨,2023,35(02):66-70,80.
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胫骨结节远端单平面截骨治疗合并骨质疏松症的老年膝骨关节炎()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年02期
页码:
66-70,80
栏目:
临床报道
出版日期:
2023-02-20

文章信息/Info

作者:
李晓敏田向东谭冶彤丁天送
(北京中医药大学第三附属医院,北京 100029)
关键词:
骨关节炎 骨质疏松 截骨术 老年人
摘要:
目的:观察胫骨结节远端单平面截骨治疗合并骨质疏松症的老年膝骨关节炎的临床疗效和安全性。方法:2020年6月至2021年6月,采用胫骨结节远端单平面截骨治疗合并骨质疏松症的老年膝骨关节炎患者42例。男15例,女27例; 年龄(67.17±5.11)岁; 左膝24例,右膝18例; 体质量指数(27.70±3.72)kg·m-2; 病程(3.52±1.58)年。所有患者均为原发性骨质疏松症(T值≤-2.5)和内侧单间室膝骨关节炎患者,均未见外侧间室半月板及软骨退变; 膝关节屈曲均>105°,无或仅有轻度的屈曲挛缩畸形。分别于术前及末次随访时,在下肢全长正位X线片上测量患者的髋-膝-踝(hip-knee-ankle,HKA)角、胫骨近端内侧角(medial proximal tibial angle,MPTA),测量并计算患者的下肢负重力线比率(weight bearing line ratio,WBLR); 在膝关节侧位X线片上测量患者的胫骨后倾角(posterior tibial slope,PTS),测量并计算患者的Caton-Deschamps指数、Blackburne-Peel指数以及Insall-Salvati指数。分别于术前及术后1个月、6个月、12个月时,采用膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分评价膝关节疼痛程度,采用西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分和Lysholm膝关节评分评价膝关节功能。随访观察并发症发生情况。结果:42例患者均顺利完成手术; 均获随访,随访时间(13.17±1.38)个月。HKA角,术前172.41°±2.04°、末次随访时182.41°±1.55°; MPTA,术前81.21°±1.59°、末次随访时92.98°±1.46°; WBLR,术前(17.91±2.56)%、末次随访时(62.24±1.33)%; PTS,术前10.41°±1.35°、末次随访时10.35°±1.31°; Caton-Deschamps指数,术前1.03±0.14、末次随访时1.02±0.14; Blackburne-Peel指数,术前0.99±0.21、末次随访时0.98±0.20; Insall-Salvati指数,术前1.14±0.17、末次随访时1.13±0.17; 膝关节疼痛VAS评分,术前(7.74±0.83)分、术后1个月(0.88±0.67)分、术后6个月(0.41±0.54)分、术后12个月(0.12±0.33)分; WOMAC评分,术前(119.14±18.39)分、术后1个月(86.21±2.48)分、术后6个月(72.19±3.54)分、术后12个月(52.81±5.21)分; Lysholm膝关节评分,术前(48.41±4.28)分、术后1个月(78.93±3.18)分、术后6个月(90.10±1.96)分、术后12个月(92.95±1.71)分。所有患者均未发生截骨区骨不愈合或延迟愈合等并发症。结论:采用胫骨结节远端单平面截骨治疗合并骨质疏松症的老年膝骨关节炎,能矫正下肢力线、维持髌骨高度、缓解膝关节疼痛、改善膝关节功能,且并发症少。

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(收稿日期:2022-10-01 本文编辑:时红磊)

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备注/Memo

备注/Memo:
基金项目:北京中医药大学重点攻关项目(2020-JYB-ZDGG-142-5) 通讯作者:田向东 E-mail:C083@bucm.edu.cn
更新日期/Last Update: 1900-01-01