腓骨近端截骨术和胫骨高位截骨术治疗膝内翻型骨性关节炎效果比较
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摘要
目的比较腓骨近端截骨术(PFO)和胫骨高位截骨术(HTO)治疗膝内翻型骨性关节炎的临床效果。方法回顾性分析2015年2月—2018年2月在山东中医药大学附属医院骨科行PFO(22例)和HTO(26例)治疗的膝内翻型骨性关节炎病人的临床资料。所有病人均获得术后随访,随访时间为3～12个月。分别于术前、术后2周、术后1月、术后3月比较两组所有病人的JOA评分、HSS评分和股胫角(FTA);分别于术前、术后2周、术后1月、术后3月、术后半年、术后1年比较两组随访时间满1年病人的JOA评分、HSS评分和FTA。结果 PFO组病人的手术时间和术中出血量均少于HTO组病人,差异有统计学意义(t=6.434、26.451,P<0.05、0.01)。术后2周和术后1月时,PFO组的JOA评分和HSS评分高于HTO组,差异均有统计学意义(F=5.642～53.921,P<0.05、0.01);术后3月至术后1年,HTO组的JOA评分高于PFO组,差异有统计学意义(F=8.685～21.521,P<0.01);术后半年至术后1年,HTO组的HSS评分高于PFO组,差异有统计学意义(F=21.381、31.899,P<0.01)。两组病人术后JOA评分和HSS评分较术前均有大幅度的改善,差异有统计学意义(F=295.609、469.315,P<0.01)。结论 PFO和HTO治疗膝内翻型骨性关节炎均可有效减轻病人的疼痛,改善病人的生活质量;PFO具有早期手术疗效显著、术中创伤小、手术时间短的优点,但HTO的远期效果要优于PFO。
Objective To investigate the clinical effect of proximal fibular osteotomy(PFO)versus high tibial osteotomy(HTO)in the treatment of knee varus osteoarthritis. Methods A retrospective analysis was performed for the clinical data of 48 patients with knee varus osteoarthritis who were treated in Department of Orthopedics,The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from February 2015 to February 2018.Among these patients,22 underwent PFO and 26 underwent HTO.Postoperative follow-up was performed for all patients,with a follow-up time of 3—12 months.Japanese Orthopaedic Association(JOA)score,Hospital for Special Surgery(HSS)knee rating score,and femoral-tibial angle(FTA)were determined before surgery and at 2 weeks,1 month,and 3 months after surgery.JOA score,HSS score,and FTA in the patients followed up for 1 year were compared between the two groups before surgery and at 2 weeks and 1,3,6,and 12 months after surgery.Results The PFO group had a significantly shorter time of operation and a significantly lower intraoperative blood loss than the HTO group(t=6.434 and 26.451,P<0.05 or P<0.01).At 2 weeks and 1 month after surgery,the PFO group had significantly higher JOA and HSS scores than the HTO group(F=5.642-53.921,P<0.05 or P<0.01).From 3 months to 1 year after surgery,the HTO group had a significantly higher JOA score than the PFO group(F=8.685-21.521,P<0.01);from 6 months to1 year after surgery,the HTO group had a significantly higher HSS score than the PFO group(F=21.381 and 31.899,P<0.01).Both groups had significant improvements in JOA and HSS scores after treatment(F=295.609 and 469.315,P<0.01). Conclusion Both PFO and HTO can effectively alleviate pain and improve quality of life in the treatment of knee varus osteoarthritis.PFO has the advantages of a marked short-term surgical outcome,little intraoperative trauma,and a short time of operation,but HTO has a better long-term effect than PFO.
Objective To investigate the clinical effect of proximal fibular osteotomy(PFO)versus high tibial osteotomy(HTO)in the treatment of knee varus osteoarthritis. Methods A retrospective analysis was performed for the clinical data of 48 patients with knee varus osteoarthritis who were treated in Department of Orthopedics,The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from February 2015 to February 2018.Among these patients,22 underwent PFO and 26 underwent HTO.Postoperative follow-up was performed for all patients,with a follow-up time of 3—12 months.Japanese Orthopaedic Association(JOA)score,Hospital for Special Surgery(HSS)knee rating score,and femoral-tibial angle(FTA)were determined before surgery and at 2 weeks,1 month,and 3 months after surgery.JOA score,HSS score,and FTA in the patients followed up for 1 year were compared between the two groups before surgery and at 2 weeks and 1,3,6,and 12 months after surgery.Results The PFO group had a significantly shorter time of operation and a significantly lower intraoperative blood loss than the HTO group(t=6.434 and 26.451,P<0.05 or P<0.01).At 2 weeks and 1 month after surgery,the PFO group had significantly higher JOA and HSS scores than the HTO group(F=5.642-53.921,P<0.05 or P<0.01).From 3 months to 1 year after surgery,the HTO group had a significantly higher JOA score than the PFO group(F=8.685-21.521,P<0.01);from 6 months to1 year after surgery,the HTO group had a significantly higher HSS score than the PFO group(F=21.381 and 31.899,P<0.01).Both groups had significant improvements in JOA and HSS scores after treatment(F=295.609 and 469.315,P<0.01). Conclusion Both PFO and HTO can effectively alleviate pain and improve quality of life in the treatment of knee varus osteoarthritis.PFO has the advantages of a marked short-term surgical outcome,little intraoperative trauma,and a short time of operation,but HTO has a better long-term effect than PFO.
引文
[1]廖德发.我国骨性关节炎流行病学调查现状[J].微创医学,2017,23(4):521-524.
[2]ALTMAN R,ASCH E,BLOCH D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis and Rheumatism,1986,29(8):1039-1049.
[3]FUJISAWA Y,MASUHARA K,SHIOMI S.The effect of high tibial osteotomy on osteoarthritis of the knee.An arthroscopic study of 54knee joints[J].The Orthopedic Clinics of North America,1979,10(3):585-608.
[4]NOYES F R,BARBER S D,SIMON R.High tibial osteotomy and ligament reconstruction in varus angulated,anterior cruciate ligament-deficient knees.A two-to seven-year followup study[J].The American Journal of Sports Medicine,1993,21(1):2-12.
[5]黄迅悟,冯会成,孙继桐,等.膝关节单髁置换中期随访报告[J].中华关节外科杂志(电子版),2013,7(4):448-453.
[6]黄野.胫骨高位截骨术治疗膝关节骨关节炎的现状[J].中华关节外科杂志(电子版),2016,10(5):470-473.
[7]张寿,曹亮.不均匀沉降理论在膝关节骨关节炎治疗中的应用[J].中华老年骨科与康复电子杂志,2016,2(1):58-61.
[8]王娟,王坤正,陈伟,等.腓骨部分切除对髋、膝、踝关节影响的研究[J].河北医科大学学报,2015,36(1):84-85.
[9]秦迪,陈伟,吕红芝,等.腓骨中上段部分切除治疗膝关节内侧间室骨性关节炎机制研究及治疗效果影响因素分析[J].河北医科大学学报,2015,36(6):727-729.
[10]EL-AZAB H,GLABGLY P,PAUL J,et al.Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy:a radiological study on 100patients[J].The American Journal of Sports Medicine,2010,38(2):323-329.
[11]张纪,杜辉,黄野,等.胫骨高位截骨术:闭合与开放楔形截骨对比[J].临床军医杂志,2016,44(2):128-132.
[12]BROUWER R W,BIERMA-ZEINSTRA S M,VAN KO-EVERINGE A J,et al.Patellar height and the inclination of the tibial plateau after high tibial osteotomy.The open versus the closed-wedge technique[J].The Journal of Bone and Joint Surgery.British Volume,2005,87(9):1227-1232.
[13]YERCAN H S,OKCU G,AYDOGDU S,et al.Clinical results of lateral closing wedge high tibial osteotomy for osteoarthritis of the knee(Oblique osteotomy with tension band fixation)[J].Acta Orthop Traumatol Turc,2004,38(2):89-95.
[14]陈国仙,李国山,林宗锦,等.3-D打印技术辅助胫骨高位截骨术治疗膝内翻畸形骨关节炎的疗效观察[J].中国修复重建外科杂志,2016,30(4):407-411.
[15]CHAE D J,SHETTY G M,WANG K H,et al.Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation[J].Knee,2011,18(4):278-284.
[16]PACCOLA C A,FOGAGNOLO F.Open-wedge high tibial osteotomy:a technical trick to avoid loss of reduction of the opposite cortex[J].Knee Surgery Sports Traumatology Arthroscopy,2005,13(1):19-22.
[17]STOFFEL K,STACHOWIAK G,KUSTER M.Open wedge high tibial osteotomy:biomechanical investigation of the modified Arthrex Osteotomy Plate(Puddu Plate)and the TomoFix Plate[J].Clinical Biomechanics(Bristol,Avon),2004,19(9):944-950.
[18]徐亚风,罗从风,张长青,等.内侧张开胫骨高位截骨术中未植骨的预后研究[J].国际骨科学杂志,2015,36(2):146-150.
[19]STAUBLI A E,DE SIMONI C,BABST R,et al.TomoFix:a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92cases[J].Injury,2003,34(Suppl 2):B55-B62.
[20]HERNIGOU P,MA W.Open wedge tibial osteotomy with acrylic bone cement as bone substitute[J].Knee,2001,8(2):103-110.
[2]ALTMAN R,ASCH E,BLOCH D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis and Rheumatism,1986,29(8):1039-1049.
[3]FUJISAWA Y,MASUHARA K,SHIOMI S.The effect of high tibial osteotomy on osteoarthritis of the knee.An arthroscopic study of 54knee joints[J].The Orthopedic Clinics of North America,1979,10(3):585-608.
[4]NOYES F R,BARBER S D,SIMON R.High tibial osteotomy and ligament reconstruction in varus angulated,anterior cruciate ligament-deficient knees.A two-to seven-year followup study[J].The American Journal of Sports Medicine,1993,21(1):2-12.
[5]黄迅悟,冯会成,孙继桐,等.膝关节单髁置换中期随访报告[J].中华关节外科杂志(电子版),2013,7(4):448-453.
[6]黄野.胫骨高位截骨术治疗膝关节骨关节炎的现状[J].中华关节外科杂志(电子版),2016,10(5):470-473.
[7]张寿,曹亮.不均匀沉降理论在膝关节骨关节炎治疗中的应用[J].中华老年骨科与康复电子杂志,2016,2(1):58-61.
[8]王娟,王坤正,陈伟,等.腓骨部分切除对髋、膝、踝关节影响的研究[J].河北医科大学学报,2015,36(1):84-85.
[9]秦迪,陈伟,吕红芝,等.腓骨中上段部分切除治疗膝关节内侧间室骨性关节炎机制研究及治疗效果影响因素分析[J].河北医科大学学报,2015,36(6):727-729.
[10]EL-AZAB H,GLABGLY P,PAUL J,et al.Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy:a radiological study on 100patients[J].The American Journal of Sports Medicine,2010,38(2):323-329.
[11]张纪,杜辉,黄野,等.胫骨高位截骨术:闭合与开放楔形截骨对比[J].临床军医杂志,2016,44(2):128-132.
[12]BROUWER R W,BIERMA-ZEINSTRA S M,VAN KO-EVERINGE A J,et al.Patellar height and the inclination of the tibial plateau after high tibial osteotomy.The open versus the closed-wedge technique[J].The Journal of Bone and Joint Surgery.British Volume,2005,87(9):1227-1232.
[13]YERCAN H S,OKCU G,AYDOGDU S,et al.Clinical results of lateral closing wedge high tibial osteotomy for osteoarthritis of the knee(Oblique osteotomy with tension band fixation)[J].Acta Orthop Traumatol Turc,2004,38(2):89-95.
[14]陈国仙,李国山,林宗锦,等.3-D打印技术辅助胫骨高位截骨术治疗膝内翻畸形骨关节炎的疗效观察[J].中国修复重建外科杂志,2016,30(4):407-411.
[15]CHAE D J,SHETTY G M,WANG K H,et al.Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation[J].Knee,2011,18(4):278-284.
[16]PACCOLA C A,FOGAGNOLO F.Open-wedge high tibial osteotomy:a technical trick to avoid loss of reduction of the opposite cortex[J].Knee Surgery Sports Traumatology Arthroscopy,2005,13(1):19-22.
[17]STOFFEL K,STACHOWIAK G,KUSTER M.Open wedge high tibial osteotomy:biomechanical investigation of the modified Arthrex Osteotomy Plate(Puddu Plate)and the TomoFix Plate[J].Clinical Biomechanics(Bristol,Avon),2004,19(9):944-950.
[18]徐亚风,罗从风,张长青,等.内侧张开胫骨高位截骨术中未植骨的预后研究[J].国际骨科学杂志,2015,36(2):146-150.
[19]STAUBLI A E,DE SIMONI C,BABST R,et al.TomoFix:a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92cases[J].Injury,2003,34(Suppl 2):B55-B62.
[20]HERNIGOU P,MA W.Open wedge tibial osteotomy with acrylic bone cement as bone substitute[J].Knee,2001,8(2):103-110.