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[1]黃永華,秦鴻飛,侯勝穩(wěn),等.膝關(guān)節(jié)鏡清理術(shù)聯(lián)合脛骨高位截骨術(shù)治療內(nèi)翻型膝骨關(guān)節(jié)炎的臨床研究[J].中醫(yī)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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膝關(guān)節(jié)鏡清理術(shù)聯(lián)合脛骨高位截骨術(shù)治療內(nèi)翻型膝骨關(guān)節(jié)炎的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年09期
頁碼:
5-10
欄目:
臨床研究
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:
黃永華; 秦鴻飛; 侯勝穩(wěn); 秦超
(南陽市中醫(yī)院,河南南陽473007)
Author(s):
HUANG Yonghua; QIN Hongfei; HOU Shengwen; QIN Chao
Nanyang TCM Hospital,Nanyang 473007,Henan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  關(guān)節(jié)鏡檢查;  截骨術(shù);  臨床試驗
Keywords:
osteoarthritis; knee;  arthroscopy;  osteotomy;  clinical trial
摘要:
目的:觀察膝關(guān)節(jié)鏡清理術(shù)聯(lián)合脛骨高位截骨術(shù)(high tibial osteotomy,HTO)治療內(nèi)翻型膝骨關(guān)節(jié)炎的臨床療效和安全性。方法:回顧性分析80例內(nèi)翻型膝骨關(guān)節(jié)炎患者的病例資料,其中采用膝關(guān)節(jié)鏡清理術(shù)聯(lián)合HTO治療42例(聯(lián)合手術(shù)組)、采用單純HTO治療38例(HTO組)。比較2組患者術(shù)前和術(shù)后1個月的Lysholm膝關(guān)節(jié)功能評分、膝部疼痛視覺模擬量表(visual analogue scale,VAS)評分、生活質(zhì)量綜合評定問卷-74(generic quality of life inventory-74,GQOL-74)評分以及術(shù)前和術(shù)后12個月的髖-膝-踝(hip-knee-ankle,HKA)角,并比較2組患者的膝關(guān)節(jié)軟骨再生及并發(fā)癥發(fā)生情況。結(jié)果:①Lysholm膝關(guān)節(jié)功能評分。術(shù)前和術(shù)后1個月,2組患者的Lysholm膝關(guān)節(jié)功能評分比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后1個月,2組患者的Lysholm膝關(guān)節(jié)功能評分均高于術(shù)前(t=46.385,P=0.000; t=35.680,P=0.000)。②膝部疼痛VAS評分。術(shù)前,2組患者的膝部疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義[(7.22±1.31)分,(7.22±1.30)分,t=0.000,P=1.000]; 術(shù)后1個月,聯(lián)合手術(shù)組患者的膝部疼痛VAS評分低于HTO組[(2.62±0.53)分,(4.11±0.71)分,t=10.701,P=0.000],2組患者的膝部疼痛VAS評分均低于術(shù)前(t=21.096,P=0.000; t=12.943,P=0.000)。③GQOL-74評分。術(shù)前,2組患者的GQOL-74評分比較,差異無統(tǒng)計學(xué)意義[(64.56±4.30)分,(65.11±4.13)分,t=0.582,P=0.564]; 術(shù)后1個月,聯(lián)合手術(shù)組患者的GQOL-74評分高于HTO組[(85.37±3.25)分,(76.79±2.59)分,t=12.967,P=0.000],2組患者的GQOL-74評分均高于術(shù)前(t=25.021,P=0.000; t=14.770,P=0.000)。④HKA角。術(shù)前和術(shù)后12個月,2組患者的HKA角比較,組間差異均無統(tǒng)計學(xué)意義(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); 術(shù)后12個月,2組患者的HKA角均大于術(shù)前(t=12.159,P=0.000; t=10.466,P=0.000)。⑤膝關(guān)節(jié)軟骨再生情況。聯(lián)合手術(shù)組膝關(guān)節(jié)軟骨再生Ⅰ級1例,Ⅱ級41例,其中非成熟再生11例、成熟再生30例; HTO組膝關(guān)節(jié)軟骨再生Ⅰ級4例,Ⅱ級34例,其中非成熟再生8例、成熟再生26例。2組患者膝關(guān)節(jié)軟骨再生情況比較,差異無統(tǒng)計學(xué)意義(χ2=1.083,P=0.298)。⑥并發(fā)癥發(fā)生情況。聯(lián)合手術(shù)組1例出現(xiàn)關(guān)節(jié)腔積血; HTO組1例出現(xiàn)矯形角度丟失,2例出現(xiàn)骨贅增生,4例出現(xiàn)關(guān)節(jié)腔積血,1例出現(xiàn)足背麻木。聯(lián)合手術(shù)組并發(fā)癥發(fā)生率小于HTO組(χ2=5.222,P=0.022)。結(jié)論:采用膝關(guān)節(jié)鏡清理術(shù)聯(lián)合HTO治療內(nèi)翻型膝骨關(guān)節(jié)炎,與單純的HTO比較,二者在改善膝關(guān)節(jié)功能、糾正下肢力線、促進膝關(guān)節(jié)軟骨再生方面療效相當(dāng),但前者較后者能更好地緩解膝關(guān)節(jié)疼痛、改善患者生活質(zhì)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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備注/Memo

備注/Memo:
基金項目:河南省中醫(yī)藥科學(xué)研究專項課題(20-21ZY2300) 通訊作者:黃永華 E-mail:[email protected]
更新日期/Last Update: 1900-01-01