【摘要】 目的探讨开放楔形胫骨高位截骨(OWHTO)联合关节镜清理术治疗内侧间室膝骨关节炎的近期疗效及其手术前后的步态变化。方法选择河北省沧州中西医结合医院2017年6月至2019年12月期间收治的内侧单间室膝骨关节炎患者80例(80膝)为研究对象,均采用OWHTO联合关节镜清理术治疗。对患者进行为期12个月的随访,采用视觉模拟疼痛评分(VAS)、美国特种外科医院膝关节评分(HSS)、美国西安大略与麦克马斯特大学骨关节炎指数评分(WOMAC)进行疗效分析;对比手术前后股骨胫骨角(FTA)、胫骨平台后倾角(PTS)、Insall-Salvati指数(IS)、下肢力线通过平台Fujisawa点等影像学指标;三维步态分析系统采集患者不同时间点膝关节运动数据,并以1∶4个体匹配原则选取20名健康志愿者正常步态与之进行对比。结果患者均获得随访,2例术后2周时出现切口浅表感染,予对症处理后好转。末次随访时,患者VAS评分与WOMAC评分降低,HSS评分升高,与术前比较均具有统计学意义( P<0.05);FTA、PTS、IS指数、下肢力线通过平台Fujisawa点较术前均有明显改善( P<0.05);患者术前站立及摆动时屈伸角、内外翻角、内外旋角均与正常膝关节存在显著差异( P<0.05),术后12个月与正常膝比较,差异无统计学意义( >0.05)。结论关节镜下清理术联合OWHTO治疗内侧间室膝骨关节炎可有效缓解患者膝关节疼痛,促进膝关节活动及功能恢复,疗效显著。随着康复时间的推移,患者患肢膝关节逐步趋于稳定,在术后12个月时患者膝关节屈伸、内外翻、内外旋等步态运动与正常膝比较无明显差异。更多还原

【Abstract】 Objective To investigate the short-term effect of opening wedge high tibial osteotomy(OWHTO) combined with arthroscopic debridement in the treatment of medial compartment knee osteoarthritis, and to analyze the changes in gait before and after surgery. Methods A total of 80 patients(80 knees) with medial compartment knee osteoarthritis who were admitted to the orthopedic surgery department of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province from June 2017 to December 2019 were selected as the research objects, and they were all treated with OWHTO combined with arthroscopic debridement treatment. Patients were followed up for 12 months, and outcomes were analyzed through visual analogue score(VAS), hospital for special surgery knee score(HSS), and Western Ontario and McMaster university(WOMAC), and through contrast imaging indicators of femur-tibia angle(FTA), posterior tibial slope(PTS), Insall-Salvati index(IS), and lower limb force line passing platform Fujisawa point before and after surgery. The knee joint motion data of patients at different time points were collected by threedimensional gait analysis system, and 20 healthy volunteers with normal gait were selected based on 1∶4 individual matching principle for comparison. Results All patients were followed up. Two cases developed superficial infection of the incision 2 weeks after the operation, which improved after symptomatic treatment. At the last follow-up, the patients’ VAS score and WOMAC score decreased, and the HSS score increased, which were statistically significant compared with those before surgery( <0.05); FTA, PTS,IS index, lower limb force line through the platform Fujisawa point were significantly improved compared with preoperative( <0.05). The angles of flexion and extension, varus and valgus angles, and internal and external rotation angles of the patients were significantly different from those of normal knee joints before operation( <0.05), and there were no significant differences compared with normal knee joints after 12 months( >0.05). Conclusion Arthroscopic debridement combined with OWHTO treatment medial compartment knee osteoarthritis can effectively alleviate knee joint pain, promote knee joint mobility and functional recovery, and have a significant curative effect. With the passage of rehabilitation time, the knee joint of the patient’s affected limb gradually stabilized. At 12 months after the operation, the gait movement of the patient’s knee joint flexion and extension, internal and external rotation, internal and external rotation was not significantly different from that of the normal knee.更多还原