首页|胫骨内侧高位截骨术治疗膝骨关节炎的疗效及对膝关节外侧间室软骨病变的影响

胫骨内侧高位截骨术治疗膝骨关节炎的疗效及对膝关节外侧间室软骨病变的影响

The influence of medial high tibial osteotomy on the effect of knee osteoarthritis and cartilage lesion of knee joint lateral compartment

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目的 探讨胫骨内侧高位截骨术治疗膝骨关节炎的疗效及对膝关节外侧间室软骨病变的影响.方法 采用胫骨内侧高位截骨术治疗104 例单侧内翻型膝骨关节炎患者,取出内固定时再次行关节镜探查膝关节外侧间室的软骨病变进展.根据截骨术时膝关节外侧间室软骨病变分级将患者分为A组(Outerbridge Ⅰ度,41例)、B组(Outerbridge Ⅱ度,35 例)、C组(Outerbridge Ⅲ度,28 例).记录疼痛VAS评分、Lysholm评分、WOM-AC评分、再次手术时膝关节外侧间室软骨病变的变化.结果 患者均获得随访,时间12~32(20.19±4.65)个月.3 组疼痛VAS评分、Lysholm评分和WOMAC评分再次手术前均较初次手术前改善(P<0.05).再次手术前,疼痛VAS评分A组和B组比较差异无统计学意义(P>0.05),且均优于C组(P<0.05);3 组Ly-sholm评分和WOMAC评分比较差异均无统计学意义(P>0.05).3 组膝关节外侧间室软骨病变最大直径再次手术时与初次手术时比较差异均无统计学意义(P>0.05).结论 对膝关节外侧间室软骨 OuterbridgeⅠ~Ⅲ度病变患者行胫骨内侧高位截骨术,不会增加外侧间室的软骨退变,仍能获得较为满意的临床效果.
Objective To investigate the influence of medial high tibial osteotomy(HTO)on the effect of knee osteo-arthritis and cartilage lesion of knee joint lateral compartment.Methods A total of 104 patients who suffered from u-nilateral varus knee osteoarthritis were treated by medial HTO.Arthroscopy was performed again to explore the pro-gression of cartilage lesions in the lateral compartment of the knee joints.They were divided into three groups accord-ing to the cartilage lesion grading of knee joint lateral compartment at osteotomy,group A(Outerbridge degree-Ⅰ,41 cases),group B(Outerbridge degree-Ⅱ,35 cases)and group C(Outerbridge degree-Ⅲ,28 cases).The pan VAS,Ly-sholm scores,WOMAC scores and the cartilage lesion changes of the knee joint lateral compartment in the re-operation were recorded.Results All cases were followed up for 12~32(20.19±4.65)months.The pain VAS,Lysholm scores,WOMAC scores of the three groups were improved in the re-operation than the primary surgery(P<0.05).Before the re-operation,there was no statistical difference in pain VAS between groups A and B(P>0.05),but both groups were better than group C(P<0.05),there were no statistical differences in Lysholm scores and WOMAC scores among three groups(P>0.05).Among three groups,the maximum diameter of cartilage lesion of the knee joint lateral compartment had no differences between the secondary operation and the primary surgery(P>0.05).Conclu-sions For the patients with cartilage lesion(Outerbridge degree Ⅰ~Ⅲ)in the lateral compartment of the knee joint,HTO does not increase the cartilage degeneration of lateral compartment,it can still obtain more satisfactory clin-ical effect.

high tibial osteotomyknee osteoarthritisknee varusarthroscopy

苏柯、王庆海、桑卫华、王军、马世云、靳胜利

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沧州市中心医院关节外科中心,河北 沧州 061000

胫骨高位截骨 膝骨关节炎 膝内翻 关节镜检查

2024

临床骨科杂志
安徽医科大学,安徽省医学会

临床骨科杂志

CSTPCD
影响因子:1.438
ISSN:1008-0287
年,卷(期):2024.27(2)
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