摘要
目的探讨不同术式治疗膝关节内侧间室骨关节炎的疗效及改善患者膝关节功能的效果。方法选取衡水市中医医院2021年1月至2023年4月收治的膝关节内侧间室骨关节炎患者作为研究对象,以首次接受膝关节内侧间室骨关节炎相关手术治疗、符合研究手术适应证等为纳入标准;合并感染性疾病、伴有外伤性骨折、骨质疏松症及骨关节手术史等为排除标准,纳入患者106例,依据患者最终治疗方式分为胫骨高位截骨组(51例)和单髁置换组(55例),胫骨高位截骨组脱落失访4例,最终纳入47例,单髁置换组脱落失访6例,最终纳入49例。胫骨高位截骨组实施胫骨高位截骨术,单髁置换组予以单髁置换术,两组均观察至患者出院,并随访12个月。t检验、重复测量方差分析和卡方检验比较两组临床疗效(术后1周),围手术期指标,膝关节活动度(术前、术后1个月)、坐立疼痛情况、膝关节功能(不同时间)、并发症发生情况(随访期间)、膝关节观察值(术前、术后12个月)。结果术后1周,较胫骨高位截骨组,单髁置换组临床总有效率更高,差异具有统计学意义(χ^(2)=5.752,P<0.05)。较胫骨高位截骨组,单髁置换组术后下床时间、住院时间均更短(t=14.461、10.619,均为P<0.05)。与术前比较,术后1个月,两组屈曲、后伸、外展、内收活动度均升高(t=130.125、113.624、70.859、69.402、53.584、51.447、26.909、27.901,均为P<0.05);两组组间比较,差异没有统计学意义(均为P>0.05)。术前到术后12个月各时间点坐立疼痛评分在胫骨高位截骨组(F=1.308)和单髁置换组(F=0.382)组内差异均无统计学意义(均为P>0.05)。术前到术后12个月各时间点两组间坐立疼痛评分差异没有统计学意义(F=1.556、0.951、1.381、0.472,均为P>0.05)。术前到术后12个月各时间点西安大略和麦克马斯特大学骨关节炎指数(WOMAC)在胫骨高位截骨组(F=1.162)和单髁置换组(F=0.663)组内差异均无统计学意义(均为P>0.05);术前到术后12个月各时间点WOMAC评分两组间差异没有统计学意义(F=1.442、0.975、0.794、1.941,均为P>0.05)。随访期间,单髁置换组并发症总发生率较胫骨高位截骨组更低(χ^(2)=4.227,P<0.05)。与术前比较,术后12个月两组胫骨平台内翻角均降低(t=5.457、12.047),其中单髁置换组更低(t=20.602);内外间隙比则均升高(t=4.060、9.726),单髁置换组更高(t=6.196),差异具有统计学意义(均为P<0.05)。结论与胫骨高位截骨术相比,单髁置换术治疗膝关节内侧间室骨关节炎患者的术后恢复时间相对更短,可调整患者膝关节力线、角度,并发症发生率低的同时疗效更加显著,但对患者术后疼痛、膝关节功能、膝关节活动度改善作用相当。
Objective To explore the curative effect of different surgical procedures on medial compartment osteoarthritis of knee joint and the effect of improving knee joint function.Methods A total of 106 patients with medial compartment osteoarthritis of knee joint treated in Hengshui Hospital of Traditional Chinese Medicine from January 2021 to April 2023 were selected as the research object.Inclusion criteria were as follows:the first surgical treatment of osteoarthritis in the medial compartment of the knee joint,with indications for surgery,etc.Patients with infectious diseases,traumatic fractures,osteoporosis and the history of bone and joint surgery were excluded.According to the final treatment,the patients were divided into two groups:the high tibial osteotomy group(the HTO group,51 cases)and the single condyle replacement group(the SCR group,55 cases).Four cases in the HTO group were lost to follow-up,and 47 cases were eventually included.Six cases in the SCR group were lost during follow-up,and 49 cases were finally included.Both groups were observed until discharge and were followed up for 12 months.The clinical efficacy(one week after operation),peri-operative indices,knee joint range of motion(before operation and one month after operation),sitting pain,knee joint function(at different time points),complications(during follow-up)and observation value of knee joint(before and 12 months after operation)were compared between the two groups by t test,repeated measurement analysis of variance and chi square test.Results One week after operation,compared with the HTO group,the total clinical effective rate in the SCR group was higher,the difference was statistically significant(χ^(2)=5.752,P<0.05).Compared with the HTO group,the time of getting out of bed and length of hospital stay in the SCR group was shorter(t=14.461,10.619,both P<0.05).Compared with the data before operation,the flexion,extension,abduction and adduction activities of the two groups all increased one month after operation(t=130.125,113.624,70.859,69.402,53.584,51.447,26.909,27.901,all P<0.05);the difference between the two groups were not statistically significant(all P>0.05).There was no statistically significant difference in the sitting pain score before surgery and 12 months after the surgery in the HTO group(F=1.308,P>0.05)nor in the SCR group(F=0.382,P>0.05).There was no significant difference between the two groups in the variance of repeated measurement of sitting pain score from preoperative to postoperative 12 months(F=1.556,0.951,1.381,0.472,all P>0.05).There was no statistical significance in the University of Western Ontario and McMaster osteoarthritis index(WOMAC)in the HTO group at each time point from before operation to 12 months after operation(F=1.162,P>0.05),and there was no statistical significance in comparing the variance of repeated measurement of WOMAC in the SCR group at each time point from before operation to 12 months after operation(F=0.663,P>0.05).There was no significant difference in the variance of repeated measurement of WOMAC score between the two groups at each time point from preoperative to postoperative 12 months(F=1.442,0.975,0.794,1.941,all P>0.05).During the follow-up period,the total incidence of complications in the SCR group was lower than that in the HTO group,the difference was statistically significant(P<0.05).Compared with the data before operation,the varus angle of tibial plateau decreased in both groups at 12 months after operation(t=5.457、12.047),especially in the SCR group(t=20.602);the ratio of internal and external space increased in both groups at 12 months after operation(t=4.060、9.726),especially in the SCR group(t=6.196),the differences were statistically significant(all P<0.05).Conclusion Compared with high tibial osteotomy,the postoperative recovery time of patients with medial compartment osteoarthritis of the knee joint treated by single condyle replacement is relatively shorter,and the line and angle of knee joint can be adjusted.The incidence of complications is lower and the curative effect is more obvious,but it has the same effect on improving postoperative pain,knee joint function and knee joint mobility.
作者
谢云港
范长海
刘荣顺
邓瑞晨
Xie Yungang;Fan Changhai;Liu Rongshun;Deng Ruichen(Waiyike(Orthopedics and Traumatology Department)of Hengshui Traditional Chinese Medicine Hospital,Hengshui 053000,China)
出处
《中华关节外科杂志(电子版)》
CSCD
2024年第6期720-728,共9页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
河北省中医药管理局2022年度中医药类科研计划课题(2022624)
关键词
膝关节
骨关节炎
截骨术
Knee joint
Osteoarthritis
Osteotomy
