腓骨近端截骨术与关节镜清理术治疗膝骨性关节炎的临床疗效对比研究

发布时间：2018-06-10 16:16

本文选题：膝骨性关节炎 + 内侧间室　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:通过前瞻性随机分组试验研究,探讨腓骨近端截骨术对比膝关节镜有限清理术在治疗早中期内侧间室受累型膝骨性关节炎的短期临床疗效差异。方法:纳入自2015年1月至2016年12月在广西骨伤医院骨关节科住院行手术治疗的内侧间室受累型膝骨性关节炎的患者共40例,对符合标准的患者按随机数字分组方法将患者分成A、B两组,每组各纳入20例,其中A组患者行单纯腓骨近端截骨术;B组患者行膝关节镜下有限清理术。对两组患者均进行术前及术后1个月、3个月、6个月、12个月随访观察,随访内容包括膝关节功能HSS、KSS评分和VAS疼痛评分以及统计术后并发症情况,并通过测量X线下膝关节内侧间隙及下肢股胫角(FTA),比较膝关节影像学改变。结果:共纳入的27例符合标准的病例,A组12例,15膝;B组15例,18膝。两组患者均获得了12-20个月的随访,A组平均(15.91±2.61)个月,B组平均(16.53±3.04)个月。两组患者术后均未发生术口或关节内感染、下肢静脉血栓、神经损伤等并发症。组内差异比较:两组患者的术后HSS、KSS评分较术前增高,VAS评分较术前低,差异具有统计学意义(P0.05);A组术后FTA和内侧关节间隙较术前分别增加(3.3±1.0)°、(1.53±0.50)mm,差异有统计学意义;B组术前与术后的FTA、内侧关节间隙比较均无统计学意义(P0.05)。组间对比:1.VAS:在术后第1个月,A组VAS评分高于B组,第3个月两组接近,而在第6、12月时A组VAS评分均低于B组,差异具有统计学意义(P0.05)。2.HSS:术后第1月,A组与B组对比无统计学意义,在第3、6、12月A组HSS评分均高于B组,差异有统计学意义。3.KSS:两组在术后第1、3月评分接近,无统计学意义,在第6、12月A组评分均高于B组,差异具有统计学意义(P0.05)。结论:在短期疗效上,单纯腓骨近端截骨术和膝关节镜有限清理手术在治疗早中期膝内侧间室型骨性关节炎均具有良好的疗效,而随着时间的的推移,腓骨近端截骨术相对来说能较好地减轻患者疼痛,改善膝关节功能,疗效优于关节镜手术,值得在临床推广应用。
[Abstract]:Objective: to investigate the short-term clinical efficacy of proximal fibula osteotomy compared with limited debridement of knee arthroscopy in the treatment of early and middle medial compartment involvement knee osteoarthritis. Methods: from January 2015 to December 2016, 40 patients with medial compartment involved knee osteoarthritis were admitted to the Department of Orthopedics and Joint of Guangxi Orthopedic Hospital. Patients who met the criteria were randomly divided into two groups: group A (n = 20) and group B (n = 20). Group A received simple proximal fibula osteotomy and group B underwent limited debridement under knee arthroscopy. The patients in both groups were followed up for 1 month, 3 months, 6 months and 12 months before and after operation. The follow-up included HSS KSS score, VAS pain score and postoperative complications. The radiographic changes of the knee joint were compared by measuring the medial space of the knee joint and the femoral tibial angle of the lower extremity. Results: a total of 27 cases were included in group A (12 cases with 15 knees) and group B (15 cases with 18 knees). Two groups of patients were followed up for 12 to 20 months, with an average of 15.91 卤2.61 months in group A and 16.53 卤3.04 months in group B. There were no complications such as intraarticular infection, venous thrombosis and nerve injury in both groups. Comparison of intra-group differences: the postoperative HSS-KSS scores in the two groups were higher than those in the preoperative patients and the VAS scores were lower than those before the operation. The difference was statistically significant in the postoperative FTA and medial articular space in group A (3.3 卤1.0) 掳and 1.53 卤0.50 mm, respectively. There was no significant difference in FTAs between pre-and post-operation in group B, and there was no significant difference in the medial articular space between group B and group B (P 0.05). VAS: the VAS score of group A was higher than that of group B at the first month after operation, but the VAS score of group A was lower than that of group B at the 6th and 12th month after operation. The difference was statistically significant (P 0.05). 2. HSS: there was no significant difference between group A and group B in the first month after operation, but the scores of VAS in group A were lower than those in group B at 6 and 12 months after operation. The score of HSS in group A was higher than that in group B in the 3rd month and 12th month, the difference was statistically significant. 3. KSS: the scores of group A were higher than that of group B at the 1st and 3rd month after operation, but the score of group A was higher than that of group B in the 6th and 12th months, the difference was statistically significant (P 0.05). Conclusion: simple proximal fibula osteotomy and limited debridement of knee arthroscopy are effective in the treatment of medial ventricular osteoarthritis of the knee in early and middle period, but with the passage of time. Proximal fibula osteotomy can relieve pain and improve knee joint function, which is worth popularizing in clinic.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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