摘要
目的比较内侧开放楔形胫骨高位截骨术(OWHTO)与人工全膝关节置换术(TKA)治疗膝关节内翻畸形的手术和术后下肢力线的疗效。方法原发性膝内侧骨关节炎伴内翻畸形病人28例,根据病人意愿分成两组,HTO组16例,行OWHTO术;TKA组12例,行TKA术。记录两组手术时间、术中出血量、切口长度、住院费用。使用目测类比法评分(VAS)、膝关节活动度(ROM)和美国特种外科医院(HSS)评价术后疗效,下肢全长X线片测量股胫角(FTA)和髋-膝-踝角(HKA)评估下肢力线。结果 HTO组手术时间(92.10±7.58)分钟、术中出血量(394.40±54.03)ml、切口长度(7.20±1.80)cm、住院费用(30893.10±1177.70)元,TKA组分别为(104.30±7.20)分钟、(505.80±70.51)ml、(10.40±2.19)cm和(45801.90±1097.18)元,两组比较差异有统计学意义(P<0.05)。两组病人术前及术后6个月VAS评分、ROM测量和HSS评分比较,差异无统计学意义(P>0.05)。HTO组术后1个月VAS(4.30±0.93)分、ROM(109.30±3.61)°、HSS(71.90±5.09)分,TKA组分别为(5.30±1.07)分、(105.10±2.75)°、HSS(67.50±4.27)分,两组比较差异有统计学意义(P<0.05)。两组FTA和HKA结果比较差异无统计学意义(P>0.05)。HTO组术后FTA(173.80±2.18)°、HKA(185.00±1.41)°,与术前FTA(183.10±4.25)°、HKA(171.40±3.50)°比较,TKA组术后FTA(174.00±1.65)°、HKA(184.30±1.66)°,与术前FTA(181.40±4.21)°、HKA(169.50±3.42)°比较,差异均具有统计学意义(P<0.05)。结论 OWHTO技术简单,创伤小,畸形矫正较精确,恢复快,花费少。
Objective To evaluate the clinical effect and the limb alignment of medial openwedge high tibial osteotomy（ OWHTO） and total knee arthroplasty（ TKA） in the treatment of varus knee.Methods 28 cases diagnosed as primary medial knee osteoarthritis with varus deformity,including 16 cases of HTO group who treated by OWHTO;12 cases in group TKA who treated by TKA. Record the operation time,intraoperative bleeding,length of incision,hospitalization expenses in two groups. Using visual analogue score（ VAS）,knee joint activity（ ROM） and the hospital for Special Surgery（ HSS） evaluated curative effect,and full length X-ray measurement of femoral tibial angle（ FTA） and hip knee ankle angle（HKA）were used to evaluate the limb alignment. Results Operation time（92. 10 ± 7. 58）min,intraoperative blood（ 394. 40 ± 54. 03） ml,incision length（ 7. 20 ± 1. 80） cm and hospitalization expenses（30893. 10 ± 1177. 70）yuan in HTO group and operation time（104. 30 ± 7. 20）min,intraoperative blood（50. 5. 80 ± 70. 51） ml,incision length（10. 40 ± 2. 19） cm and hospitalization expenses（45801. 90 ±1097. 18） yuan in TKA group,respectively,there was significant difference between the two groups（ P〈0. 05）. There were no statistically significant differences in VAS scores,ROM measurements and HSS scores between the two groups before and six months after surgery（ P〈0. 05）. Comparing with VAS（4. 30 ± 0. 93）,ROM（109. 30 ± 3. 61）and HSS（71. 90 ± 5. 09）in HTO group than TKA group[（5. 30 ±1. 07）,（105. 10 ± 2. 75） °,（67. 50 ± 4. 27）] at six months after surgery,the difference was statistically significant（ P〈0. 05）. There was no significant difference between FTA and HKA between the two group（P〈0. 05）. Compared with FTA before and after surgery[（183. 10 ± 4. 25）°,（173. 80 ± 2. 18）°],HKA before and after surgery[（171. 40 ± 3. 50） °,（185. 00 ± 1. 41） °] in HTO group,respectively,there were singnficant difference（ P〈0. 05）. Compared with FTA before and after surgery [（ 181. 40 ± 4. 21） °,（174. 00 ±1. 65）°],HKA before and after surgery[（169. 50 ±3. 42）°,（184. 30 ±1. 66）°]in TKA group,respectively,there were singnficant difference（ P〈0. 05）. Conclusion Medial open-wedge high tibial osteotomy had the advantages of simple technique,small trauma,accurate deformity correction,rapid recovery,less cost and good clinical effect.
作者
金志辉
彭昊
方洪松
陈森
张雷
JIN Zhihui;PENG Hao;FANG Hongsong(Department of Orthopaedics,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《临床外科杂志》
2018年第7期546-549,共4页
Journal of Clinical Surgery
