两种胫骨高位截骨方式治疗膝内侧室骨性关节炎疗效比较
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摘要
[目的]比较张式胫骨高位截骨术(HTO)和花式HTO治疗膝内侧间室骨性关节炎(MCOA)的早期临床疗效。[方法]本研究包括两组共30例MCOA患者,其中15例接受张式HTO,15例接受花式HTO手术治疗。记录并比较两组患者的手术时间、出血量及手术并发症等。分别于术前、术后3个月及术后6个月行疼痛视觉评分(VAS)、美国特种外科医院膝关节评分(HSS评分)和美国膝关节协会评分(KSS评分)。此外,对患者进行影像评估。[结果]张式HTO组平均手术时间为(78.47±7.54) min,花式HTO组平均为(67.40±6.58) min,两者差异有统计学意义(P<0.05);但两组手术出血量差异无统计学意义(P>0.05),此外,两组手术并发症发生率差异无统计学意义(P>0.05)。两组患者均获得6～10个月的随访,术后3个月及术后6个月两组患者的VAS评分、HSS评分及KSS评分均优于术前(P<0.01),且术后随着时间推移评分存在逐渐好转趋势(P<0.05),但各相应时间点两组之间差异均无统计学意义(P>0.05)。两组患者术后胫股角均较术前减小(P<0.01),末次随访时张氏HTO组胫股角大于花式HTO组(P<0.05)。[结论]张式HTO与花式HTO虽然在具体胫骨截骨位置,腓骨截骨与否,以及对力线恢复的程度存在明显差异,却取得了类似的早期手术效果,均可有效缓解疼痛、改善膝关节功能。
[Objective] To compare the early clinical outcomes of Zhang.s high tibial osteotomy(HTO) versus Hua.s HTO for treatment of medial compartmental osteoarthritis(MCOA) of the knee. [Methods] A total of 30 patients with MCOA were included in this study. Of them, 15 patients underwent Zhang.s HTO while the remaining 15 patients received Hua.s HTO. The perioperative data, including operation time, intraoperative bleeding and surgical complications, were recorded and compared between the two groups. The visual analogue score(VAS) for pain, Hospital for Special Surgery knee score(HSS) and American Knee Society knee score(KSS) were used for evaluation of the clinical condition before operation, at 3 and 6 months after operation respectively. In addition, imaging assessment was conducted. [Results] The Zhang.s HTO group consumed significantly longer operation time [(78.47±7.54) mins] compared to the Hua.s HTO group [(67.40±6.58) mins, P=0.014], although the difference in intraoperative blood loss between the two groups was not significant(P>0.05). The incision length of Zhang.s group[(7.40±1.35) cm] was longer than that of Hua.s group [(6.53±1.51) cm], but its difference and the difference in operative complications between the two groups were not statistically significant(P>0.05). There was no significant difference in hospitalization days between the Zhang.s group [(7.07±1.53) days]and the Hua.s group [(7.86±1.60) days, P>0.05]. The patients were followed up for 6～10 months. The VAS, HSS and KSS scores in both groups significantly improved as time went on(P<0.05), associated with statistically significant differences between the scores before operation and those at3 and 6 months after operation(P<0.05). However, there was no significant difference between the two groups regarding to any aforesaid parameters at any corresponding time point(P>0.05). In term of radiographic measurement, the tibiofemoral angles in both groups significantly decreased after operation compared with those before operation(P<0.05). At the latest follow-up the Zhang's group had significantly greater tibiofemoral angle than the Hua's group(P<0.05), despite of no a statistically significant difference between them before operation(P>0.05).The difference in the healing time of osteotomy between the Zhang's group [(16.20±3.01) weeks] and the Hua's group [(17.53±3.54) weeks] was not significant(P=0.276). [Conclusion]Although there are obvious differences between Zhang's HTO and Hua's HTO in the specific osteotomy position, accompanied with fibular osteotomy or not, and the extent of mechanical line correction, the two procedures achieve similar early surgical results, which do effectively alleviate pain and improve knee joint function.
[Objective] To compare the early clinical outcomes of Zhang.s high tibial osteotomy(HTO) versus Hua.s HTO for treatment of medial compartmental osteoarthritis(MCOA) of the knee. [Methods] A total of 30 patients with MCOA were included in this study. Of them, 15 patients underwent Zhang.s HTO while the remaining 15 patients received Hua.s HTO. The perioperative data, including operation time, intraoperative bleeding and surgical complications, were recorded and compared between the two groups. The visual analogue score(VAS) for pain, Hospital for Special Surgery knee score(HSS) and American Knee Society knee score(KSS) were used for evaluation of the clinical condition before operation, at 3 and 6 months after operation respectively. In addition, imaging assessment was conducted. [Results] The Zhang.s HTO group consumed significantly longer operation time [(78.47±7.54) mins] compared to the Hua.s HTO group [(67.40±6.58) mins, P=0.014], although the difference in intraoperative blood loss between the two groups was not significant(P>0.05). The incision length of Zhang.s group[(7.40±1.35) cm] was longer than that of Hua.s group [(6.53±1.51) cm], but its difference and the difference in operative complications between the two groups were not statistically significant(P>0.05). There was no significant difference in hospitalization days between the Zhang.s group [(7.07±1.53) days]and the Hua.s group [(7.86±1.60) days, P>0.05]. The patients were followed up for 6～10 months. The VAS, HSS and KSS scores in both groups significantly improved as time went on(P<0.05), associated with statistically significant differences between the scores before operation and those at3 and 6 months after operation(P<0.05). However, there was no significant difference between the two groups regarding to any aforesaid parameters at any corresponding time point(P>0.05). In term of radiographic measurement, the tibiofemoral angles in both groups significantly decreased after operation compared with those before operation(P<0.05). At the latest follow-up the Zhang's group had significantly greater tibiofemoral angle than the Hua's group(P<0.05), despite of no a statistically significant difference between them before operation(P>0.05).The difference in the healing time of osteotomy between the Zhang's group [(16.20±3.01) weeks] and the Hua's group [(17.53±3.54) weeks] was not significant(P=0.276). [Conclusion]Although there are obvious differences between Zhang's HTO and Hua's HTO in the specific osteotomy position, accompanied with fibular osteotomy or not, and the extent of mechanical line correction, the two procedures achieve similar early surgical results, which do effectively alleviate pain and improve knee joint function.
引文
[1]Adebajo AO.Pattern of osteoarthritis in a West African teaching hospital[J].Ann Rheum Dis,1991,50(1):20-22.
[2]Cushnaghan J,Dieppe P.Study of 500 patients with limb joint osteoarthritis.I.Analysis by age,sex,and distribution of symptomatic joint sites[J].Ann Rheum Dis,1991,50(1):8-13.
[3]Slemenda CW.The epidemiology of osteoarthritis of the knee[J].Curr Opin Rheumatol,1992,4(4):546-551.
[4]Jackson JP,Waugh W.Tibial osteotomy for osteoarthritis of the knee[J].Proc R Soc Med,1960,53(10):888.
[5]Insall JN,Ranawat CS,Aglietti P,et al.A comparison of four models of total knee-replacement prostheses[J].J Bone Joint Surg Am,1976,58(6):754-765.
[6]Insall JN,Dorr LD,Scott RD,et al.Rationale of the Knee Society clinical rating system[J].Clin Orthop,1989,248(248):13-14.
[7]Nerhus TK,Ekeland A,Solberg G,et al.No difference in time-dependent improvement in functional outcome following closing wedge versus opening wedge high tibial osteotomy:a randomised controlled trial with two-year follow-up[J].Bone Joint J,2017,99-B(9):1157-1166.
[8]Ryu SM,Park JW,Na HD,et al.High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients[J].Knee Surg Relat Res,2018,30(1):17-22.
[9]郑占乐,于沂阳,高石军,等.胫骨高位截骨嵌入可吸收网状垫片治疗膝关节骨关节炎的初步临床应用[J].河北医科大学学报,2016(8):988-989,封3.
[10]Ogawa H,Matsumoto K,Akiyama H.The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy:a case control study[J].Bone Joint J,2017,99-B(7):887-893.
[2]Cushnaghan J,Dieppe P.Study of 500 patients with limb joint osteoarthritis.I.Analysis by age,sex,and distribution of symptomatic joint sites[J].Ann Rheum Dis,1991,50(1):8-13.
[3]Slemenda CW.The epidemiology of osteoarthritis of the knee[J].Curr Opin Rheumatol,1992,4(4):546-551.
[4]Jackson JP,Waugh W.Tibial osteotomy for osteoarthritis of the knee[J].Proc R Soc Med,1960,53(10):888.
[5]Insall JN,Ranawat CS,Aglietti P,et al.A comparison of four models of total knee-replacement prostheses[J].J Bone Joint Surg Am,1976,58(6):754-765.
[6]Insall JN,Dorr LD,Scott RD,et al.Rationale of the Knee Society clinical rating system[J].Clin Orthop,1989,248(248):13-14.
[7]Nerhus TK,Ekeland A,Solberg G,et al.No difference in time-dependent improvement in functional outcome following closing wedge versus opening wedge high tibial osteotomy:a randomised controlled trial with two-year follow-up[J].Bone Joint J,2017,99-B(9):1157-1166.
[8]Ryu SM,Park JW,Na HD,et al.High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients[J].Knee Surg Relat Res,2018,30(1):17-22.
[9]郑占乐,于沂阳,高石军,等.胫骨高位截骨嵌入可吸收网状垫片治疗膝关节骨关节炎的初步临床应用[J].河北医科大学学报,2016(8):988-989,封3.
[10]Ogawa H,Matsumoto K,Akiyama H.The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy:a case control study[J].Bone Joint J,2017,99-B(7):887-893.
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