腓骨近端截骨术治疗早中期膝关节骨关节炎的初期疗效及影像学评价

发布时间：2018-10-15 18:37

【摘要】：目的:评价腓骨近端截骨术治疗早中期膝关节骨关节炎的初期疗效。方法:回顾性收集2015年2月至2016年4月于山西大医院骨科行腓骨近端截骨术治疗的膝关节骨关节炎患者25例(27膝),于术前、术后3 d、3个月、6个月及1年记录疼痛视觉模拟评分(VAS),美国膝关节协会评分(KSS),膝关节Lysholm评分,胫股角(FTA)、胫骨平台内翻角(TP-TSA)、髋-膝-踝角(HKA)、膝关节外侧间室高度及腓骨头外侧结节到膝关节外侧平台距离的变化。结果:25例(27膝)患者均获得1年随访;手术时间平均(64±27.5)min;术中出血量平均(16±9.5)ml;术后住院时间平均(4±1.2)d。与术前相比,术后3d、3月、6月及1年的VAS评分均降低(F=94.446,P0.05)、KSS临床评分升高(F=69.820,P0.05)、KSS功能评分升高(F=58.363,P0.05)及膝关节Lysholm评分升高(F=51.410,P0.05),差异具有统计学意义。至末次随访时,24例(26膝)患者胫骨平台内翻角由术前(84.3±2.3)°增至术后(85.0±2.4)°,差异具有统计学意义(t=-2.112,P0.05);膝关节外侧间室高度由术前(0.731±0.104)cm降至术后(0.665±0.960)cm,差异具有统计学意义(t=5.470,P0.05);腓骨头外侧结节到胫骨外侧平台距离由术前(3.370±0.411)cm增至术后(3.495±0.397)cm,差异具有统计学意义(t=-4.436,P0.05)。14例患者术前术后均拍摄双下肢全长负重X线,测量髋-膝-踝角由术前(173.9±4.3)°增至术后(176.0±3.2)°,差异具有统计学意义(t=-3.640,P0.05);术前(180.0±2.9)°、术后(179.5±2.9)°的胫股角无变化(t=1.204,P0.05)。结论:腓骨近端截骨术治疗早中期膝内侧间室骨关节炎的初期疗效良好,能明显缓解患者膝关节疼痛症状,改善膝关节功能,提高生活质量。
[Abstract]:Objective: to evaluate the initial effect of proximal fibula osteotomy on early and middle stage knee osteoarthritis. Methods: Twenty-five patients (27 knees) with osteoarthritis of knee joint treated with proximal fibula osteotomy from February 2015 to April 2016 were retrospectively collected. Visual analogue score of pain was recorded at 3 days, 3 months, 6 months and 1 year after operation. (VAS), American knee Association score (KSS), knee joint Lysholm score were recorded. The changes of the tibial plateau varus angle (TP-TSA), the height of the lateral interventricular chamber of the knee joint of (HKA), and the distance from the lateral tubercle of the head of fibula to the lateral plateau of the knee joint in tibiofemoral angle (FTA),). Results: Twenty-five patients (27 knees) were followed up for 1 year, and the mean time of operation was (64 卤27.5) min;, the average amount of bleeding was (16 卤9.5) ml;, the average hospital stay was (4 卤1.2) days. Compared with before operation, the VAS scores of 3 days, 3 months, 6 months and 1 year after operation were all decreased (FG 94.446%, P 0.05, P < 0.05, P < 0.05), and the scores of Lysholm of knee joint were significantly higher (P < 0.05) than those before operation (P 0.05, P 0.05), and the scores of Lysholm in knee joint were significantly higher than those before operation (P 0.05, P < 0.05) (P < 0.05). To the last follow-up, the tibial plateau varus angle increased from (84.3 卤2.3) 掳to (85.0 卤2.4) 掳after operation in 24 patients (26 knees), the difference was statistically significant (t = 2.112), the height of lateral interventricular chamber of knee joint decreased from (0.731 卤0.104) cm before operation to (0.665 卤0.960) cm, after operation (t = 5.4700.05), and the lateral ventricular height of knee joint decreased from (0.731 卤0.104) cm to (0.665 卤0.960) cm, after operation. The distance from the lateral tubercle to the lateral tibial plateau was increased from (3.370 卤0.411) cm to (3.495 卤0.397) cm, after operation. The hip knee ankle angle was measured from (173.9 卤4.3) 掳before operation to (176.0 卤3.2) 掳after operation, the difference was statistically significant (t _ (3.640) P _ (0.05), the tibiofemoral angle of (180.0 卤2.9) 掳before and (179.5 卤2.9) 掳after operation had no change (t _ (1.204) P 0.05). Conclusion: proximal fibula osteotomy is effective in treating osteoarthritis of medial compartment of knee in early and middle period. It can obviously relieve the symptoms of knee joint pain, improve the function of knee joint and improve the quality of life.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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