摘要
目的:比较腓骨近端截骨术(proximal fibular osteotomy,PFO)及膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗不同严重程度膝骨关节炎的临床疗效。方法:回顾性分析2015年6月至2017年10月收治的膝骨关节炎患者53例,根据手术方式分为PFO组26例与UKA组27例。根据Kellygren-Lawrence影像学分级标准:PFO组,Ⅱ级5例,Ⅲ级11例,Ⅳ级10例;UKA组,Ⅱ级7例,Ⅲ级9例,Ⅳ级11例。比较两组患者术中出血量、手术时间和术后住院时间;分别于术前、术后3个月、1年对患者定期门诊随访,比较同组各时间点的西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)评分和胫股角角度,并比较两组间各时间的WOMAC评分和胫股角角度。结果:53例患者均获得随访,随访时间12~24(16.6±4.8)个月。PFO组比UKA组术中出血量少、手术时间短和术后住院时间短(P<0.05)。两组术后1年时疼痛、僵硬和躯体功能评分均较术前改善(P<0.05);术后1年UKA组的疼痛、僵硬和躯体功能评分均优于PFO组(P<0.05)。PFO组术后3个月和1年时WOMAC指数较术前均明显好转(P<0.05);术后3个月、1年UKA组Ⅳ级患者WOMAC指数评分明显优于PFO组Ⅳ级患者(P<0.05);术后3个月PFO组Ⅱ、Ⅲ级患者WOMAC指数评分优于UKA组(P<0.05)。两组Ⅱ、Ⅲ级患者的胫股角度均逐渐降低(P<0.05);UKA组Ⅳ级术后胫股角均小于PFO组Ⅳ级患者(P<0.05)。结论:PFO相较于UKA具有创伤小、恢复快、花费少,在Ⅱ、Ⅲ级膝骨关节炎患者中疗效相当于或超过UKA,是一种可以选择的治疗膝骨关节炎的手术方式。
Objective:To compare the clinical effect of proximal fibular osteotomy(PFO)and single condyle replacement(UKA)in the treatment of knee osteoarthritis of different severity.Methods:From June 2015 to September 2017,53 patients with knee osteoarthritis were analyzed retrospectively.According to the operation mode,they were divided into PFO group(26 cases)and UKA group(27 cases).According to Kellygren-Lawrence imaging classification standard:PFO group,5 cases of gradeⅡ,11 cases of gradeⅢ,10 cases of gradeⅣ;UKA group,7 cases of gradeⅡ,9 cases of gradeⅢ,11 cases of gradeⅣ.The amount of intraoperative bleeding,operation time and postoperative hospital stay were compared between the two groups.The patients were followed up regularly in the outpatient clinic before operation,3 months after operation and 1 year after operation.The WOMAC score and the angle of tibiofemoral angle at each time point in the same group were compared,and the OMAC score and the angle of tibiofemoral angle at each time between the two groups were compared.Results:Fifty-three patients were followed up for 12 to 24(16.6±4.8)months.Compared with UKA group,PFO group had less intraoperative bleeding,shorter operative time and shorter postoperative hospital stay(P<0.05).The scores of pain,stiffness and body function in UKA group were better than those in PFO group(P<0.05).After 3 months and 1 year,the WOMAC index in PFO group was significantly improved(P<0.05);after 3 months and 1 year,the WOMAC index in UKA group was significantly better than that in PFO group(P<0.05);after 3 months,the WOMAC index in PFO group was significantly better than that in UKA group(P<0.05).The tibiofemoral angle of gradeⅡandⅢpatients in both groups decreased gradually(P<0.05);the tibiofemoral angle of gradeⅣpatients in UKA group was smaller than that of gradeⅣpatients in PFO group(P<0.05).Conclusion:Compared with UKA,PFO has the advantages of small trauma,fast recovery and low cost.The curative effect of PFO is equal to or more than UKA in the patients with gradeⅡandⅢknee osteoarthritis.It is an alternative surgical method for the treatment of knee osteoarthritis.
作者
董伊隆
钱约男
李一民
翟利锋
许桦
蔡春元
DONG Yi-long;QIAN Yue-nan;LI Yi-min;ZHAI Li-feng;XU Hua;CAI Chun-yuan(Department of Orthopaedics,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,Zhejiang,China)
出处
《中国骨伤》
CAS
CSCD
2020年第1期4-10,共7页
China Journal of Orthopaedics and Traumatology
关键词
骨关节炎
膝
关节成形术
置换
膝
腓骨
截骨术
Osteoarthritis
knee
Arthroplasty
replacement
knee
Fibula
Osteotomy
