【摘要】 目的探讨X线测量膝关节外翻应力角(valgus stress angle,Vg SA)与腓骨近端截骨术治疗膝关节骨关节炎疗效的关系。方法前瞻性收集2014年11月至2015年5月山西省晋中市第一人民医院确诊为膝关节骨关节炎且符合纳入及排除标准的患者35例(41膝),其中男性2例,女性33例,双膝6例。术前均拍下肢负重位全长片、测量非负重位Vg SA。根据Vg SA角度将患者分为:<2°组、2°~5°组、>5°组。分别于术后3、6、12个月随访并比较三组患者术前与末次随访时的西安大略和麦克马斯特大学骨关节炎指数(western ontario and Mc Master Universities osteoarthritis index,WOMAC)变化情况。结果所有患者均获6~13个月随访,平均(7.8±2.7)个月。三组患者手术时间比较,差异无统计学意义(P>0.05)。术前三组患者的WOMAC指数相比差异无统计学意义(F=0.198,P>0.05),末次随访时,2°~5°组(15±5)患者的WOMAC指数小于<2°(20±8)和>5°组(20±6),差异有统计学意义(F=4.032,P<0.05);且2°~5°组(37%)的WOMAC指数改善率高于>5°组(34%)及<2°组(32%),差异有统计学意义(F=5.431,P<0.01)。结论通过Vg SA的测量有助于把握腓骨近端截骨术适应证,Vg SA介于2°~5°之间的膝关节骨关节炎患者可获得更为满意的疗效。更多还原

【Abstract】 Objective To compare the efficacy of proximal fibular osteotomy treating knee osteoarthritis at different valgus stress angle(Vg SA).Methods From November 2014 to May 2015,35patients(41 knees) with knee osteoarthritis were treated with proximal fibular osteotomy in Jinzhong First People’s Hospital,including 2 males and 33 females and 6 bilateral knees.Before surgery,all patients were covered with weight-bearing full-length X-ray.At the same time,the Vg SA were measured at nonweightbearing position.Patients were then divided into <2° group,2°-5° group and >5° group based on Vg SA.Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC) were recorded before and at the last follow-up,comparsion was done to evaluate the efficacy of proximal fibular osteotomy.Results All cases were followed up for 6-13 months(mean 7.8 ± 2.7 months).There was no significant difference of WOMAC between three groups(F=0.198,P>0.05) preopratively.At the last follow-up,the WOMAC in the2°-5° group(15±5) were significantly lower than those in the <2°(20±8) and >5° group(20±6)(F=4.032,P<0.01),and WOMAC improvement rate in the 2°-5° group(37%) were also significantly lower than <2°(32%) and >5°(34%) group(F=5.431,P<0.05).Conclusion Vg SA can be used in proximal fibular osteotomy to assure surgical outcoms,and knee osteoarthritis patients of 2°-5° Vg SA obtain more satisfactory therapeutic effect.更多还原