摘要
背景:开放楔形胫骨高位截骨对于内侧间室膝骨关节炎合并膝内翻患者疗效明确,但目前关于力线矫正点的选择仍以Fujisawa点作为参考,个体化力线矫形是否能获得更优越的临床疗效?目的:探讨开放楔形胫骨高位截骨术中个体化下肢力线矫形治疗内侧间室膝骨关节炎的短期疗效。方法:选择2016年6月至2018年5月无锡市人民医院骨科因内侧间室膝骨关节炎行开放楔形胫骨高位截骨治疗的46例患者。根据X射线片、MRI综合评估患膝并划分退变等级(Ⅰ-Ⅲ级),其中Ⅰ,Ⅱ级患者随机分为个体化组及对照组,每组16例;14例Ⅲ级患者作为Fujisawa组。个体化组轻度退变Ⅰ级矫正下肢力线至胫骨平台50%点,中度退变Ⅱ级矫正至胫骨平台外侧55%点;对照组、Fujisawa组均矫正力线至62.5%点。测量评估术后下肢力线,比较术前、术后膝关节活动度、股胫角、胫骨近端内侧角;随访术前及术后3,6,12个月患膝的美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数,比较患者术后综合满意度的自评分。结果与结论:(1)所有患者均获得12个月随访;(2)3组下肢力线矫形结果满意,术后膝关节活动度、胫骨近端内侧角较术前明显增加,股胫角明显减少(P<0.05);(3)随着随访时间延长,3组患者的美国特种外科医院评分显著增加,西安大略和麦克马斯特大学骨关节炎指数显著减少,组内不同时点差异有显著性意义(P<0.05);个体化组术后3,6个月美国特种外科医院评分高于对照组,西安大略和麦克马斯特大学骨关节炎指数低于对照组,差异有显著性意义(P<0.05);个体化组及对照组术后12个月美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数差异无显著性意义(P>0.05);(4)所有患者对手术矫形效果满意,个体化组术后综合满意评分高于对照组,差异有显著性意义(P<0.05);(5)结果表明,个体化开放楔形胫骨高位截骨通过准确地力线矫形,有利于膝关节早期功能恢复,提升患者满意度。
BACKGROUND: Open wedge high tibial osteotomy can achieve significant clinical efficacy for patients with medial compartment knee osteoarthritis and genu varus. However, Fujisawa point has been recognized as a reference for the correction of lower limb alignment. Can individualized orthopedics in lower limb alignment obtain better clinical efficacy? OBJECTIVE: To explore short-term efficacy of individualized orthopedics in lower limb alignment for medial compartment knee osteoarthritis through open wedge high tibial osteotomy. METHODS: Totally 46 patients with medial compartment knee osteoarthritis treated by open wedge high tibial osteotomy from June 2016 to May 2018 in Department of Orthopedics, Wuxi People’s Hospital were enrolled in this study. X-ray and MRI were used to evaluate the knee and I-III degeneration grades were classified. Patients at Grade I and II were randomly divided into individualized orthopedics group and control group with 16 cases in each group. Patients at grade III were classified as Fujisawa group with 14 cases. In the individualized orthopedics group, mild grade I and moderate grade II respectively corrected lower limb alignment to 50% and 55% of lateral tibial plateau, while control group and Fujisawa group all corrected the alignment to 62.5% point. Postoperative lower limb alignment, pre-and post-operative range of motion, femoral-tibial angle and medial proximal tibial angle of the knee were measured and evaluated. The hospital for special surgery score and the Western Ontario and McMaster Universities osteoarthritis index score were followed up before operation, 3, 6 and 12 months after operation, while postoperative self-satisfaction of patients was also compared. RESULTS AND CONCLUSION:(1) All patients were followed up for 12 months.(2) Three groups achieved satisfactory lower limb alignment. Range of motion and medial proximal tibial angle increased and femoral-tibial angle decreased at postoperative stage(P < 0.05).(3) Over time, hospital for special surgery scores increased and Western Ontario and McMaster Universities osteoarthritis index scores decreased statistically in three groups(P < 0.05). Compared to control group, hospital for special surgery scores of the individualized orthopedics group were improved 3 and 6 months postoperatively(P < 0.05), while Western Ontario and McMaster Universities osteoarthritis index scores of the individualized orthopedics group decreased significantly 3 and 6 months after operation(P < 0.05). There were no obvious differences in hospital for special surgery and Western Ontario and McMaster Universities osteoarthritis index scores at 12 months between the control and individualized orthopedics groups(P > 0.05).(4) All patients were satisfied with the surgical efficacy. Postoperative self-satisfaction scores of individualized orthopedics group were superior to that of control group(P < 0.05).(5) According to the results, individualized open wedge high tibial osteotomy is benefit to obtain early functional rehabilitation of the knee through accurate correction of lower limb alignment. It can also improve patient satisfaction.
作者
俞颖豪
赵继军
刘冬铖
周子红
吴沼锋
冯德宏
Yu Yinghao;Zhao Jijun;Liu Dongcheng;Zhou Zihong;Wu Zhaofeng;Feng Dehong(Department of Orthopedics,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Wuxi 214000,Jiangsu Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第27期4310-4316,共7页
Chinese Journal of Tissue Engineering Research
关键词
膝关节
内侧间室
骨关节炎
膝内翻
开放楔形胫骨高位截骨
个体化
下肢力线
矫形
knee joint
medial compartment
osteoarthritis
genu varus
open wedge high tibial osteotomy
individualized
lower limb alignment
orthopedics
