摘要
目的对比胫骨结节下单平面截骨术(DTT-HTO)与传统胫骨内侧高位开放楔形截骨术(OWHTO)治疗内侧单间室膝关节骨性关节炎(KOA)患者对髌骨高度相关指数及美国特种外科医院(HSS)评分、视觉模拟评分(VAS)的影响。方法回顾性分析2021年1月至2022年12月郑州市骨科医院收治的94例内侧单间室KOA患者的临床资料,根据手术方式不同分为DTT-HTO组(n=50)与OWHTO组(n=44)。比较两组患者的围术期出血量、切口长度和手术时间等手术情况;于术前、术后即刻测量两组患者的卡通-德尚普指数(CDI)、布莱克本-皮尔指数(BPI)、因萨尔-萨尔瓦蒂指数(ISI)等髌骨高度相关指数;并于术后3个月、6个月对两组患者进行随访,采用美国特种外科医院(HSS)膝关节功能评分标准评估膝关节功能,使用视觉模拟评分(VAS)评估患者疼痛程度,并测量股胫角和胫骨平台后倾角。结果两组患者的围术期出血量、切口长度比较差异均无统计学意义(P>0.05);DTT-HTO组患者的手术时间为(53.41±7.84)min,明显短于OWHTO组的(66.68±8.65)min,差异有统计学意义(P<0.05)。术前,两组患者的CDI、BPI、ISI比较差异均无统计学意义(P>0.05);术后即刻,DTT-HTO组的CDI及BPI分别为0.96±0.43、0.78±0.23,明显高于OWHTO组的CDI(0.81±0.26)及BPI(0.63±0.17),差异均有统计学意义(P<0.05),但两组患者的ISI比较差异无统计学意义(P>0.05)。术前及术后6个月,两组患者的HSS评分、VAS评分比较差异均无统计学意义(P>0.05);术后3个月,DTT-HTO组患者的HSS评分为(78.64±6.86)分,明显高于OWHTO组的(66.38±5.65)分,而VAS评分为(2.57±0.63)分,明显低于OWHTO组的(3.56±0.72)分,差异均有统计学意义(P<0.05)。术前、术后3个月和6个月,两组患者的股胫角、胫骨平台后倾角比较差异均无统计学意义(P>0.05)。结论两种术式各具特点,DTT-HTO在手术时间和术后早期膝关节功能及疼痛缓解方面具有一定优势,而在中期膝关节功能和下肢力线改善方面两种术式效果相当,临床应根据患者具体情况选择合适的手术方式。
Objective To compare the effects of distal tibial tubercle high tibial osteotomy(DTT-HTO)and tra-ditional medial open wedge high tibial osteotomy(OWHTO)on patella height related indexes as well as Hospital for Special Surgery(HSS)knee scores and Visual Analogue Scale(VAS)pain scores in patients with medial unicompartmen-tal knee osteoarthritis(KOA).Methods A retrospective analysis was performed on 94 patients with medial unicompart-mental KOA treated in Zhengzhou Orthopaedic Hospital from January 2021 to December 2022.According to different osteotomy techniques,patients were divided into a DTT-HTO group(n=50)and an OWHTO group(n=44).Peri-opera-tive blood loss,incision length,and operation time were compared between the two groups.Patella height related index-es(Caton-Deschamps Index[CDI],Blackburne-Peel Index[BPI],Insall-Salvati Index[ISI])were measured pre-opera-tively and immediately post-operatively.At 3 and 6 months after surgery,all patients were followed up with the HSS knee score to assess knee function,the VAS to evaluate pain,and measurements of femoral-tibial angle(FTA)and poste-rior tibial slope(PTS).Results No significant differences were found between the two groups in peri-operative blood loss or incision length(P>0.05).Operation time in the DTT-HTO group was(53.41±7.84)min,significantly shorter than(66.68±8.65)min in the OWHTO group(P<0.05).Before surgery,CDI,BPI,and ISI showed no significant differences between the two groups(P>0.05).Immediately after surgery,CDI and BPI in the DTT-HTO group were 0.96±0.43 and 0.78±0.23,significantly higher than corresponding 0.81±0.26 and 0.63±0.17 in the OWHTO group(both P<0.05),while ISI remained similar with 1.01±0.17 versus 1.02±0.15(P>0.05).Before and at 6 months after surgery,HSS and VAS scores did not differ significantly between groups between the two groups(P>0.05).At 3 months after surgery,however,the DTT-HTO group achieved a higher HSS score and a lower VAS score than the OWHTO group(both P<0.05):HSS score,(78.64±6.86)vs(66.38±5.65);VAS score,(2.57±0.63)vs(3.56±0.72).Before surgery and at 3 and 6 months after surgery,no significant intergroup differences were observed in femorotibial angle or posterior tibial slope(P>0.05).Conclusion Each osteotomy technique has its own characteristics.DTT-HTO offers a shorter operation time,early postoperative knee function,and pain relief,whereas both osteotomy techniques provide comparable medium-term knee function and lower limb alignment correction.In clinical practice,the choice of appropriate osteotomy techniques should therefore be individualized to the patient's specific condition.
作者
曹常松
关健
侯颖周
陈杰
王爱国
CAO Chang-song;GUAN Jian;HOU Ying-zhou;CHEN Jie;WANG Ai-guo(Department of Lower Limb Orthopedics,Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,CHINA)
出处
《海南医学》
2025年第13期1890-1894,共5页
Hainan Medical Journal
基金
2022年度河南省医学科技攻关计划项目(编号:LHGJ20220892)。
