腓骨上段截骨联合关节镜清理术治疗膝关节内侧间室骨性关节炎的效果观察

王晓成; 贾博; 王昱; 吴云健; 王强

doi:10.16766/j.cnki.issn.1674-4152.003799

腓骨上段截骨联合关节镜清理术治疗膝关节内侧间室骨性关节炎的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.003799

浙江中医药大学附属金华中医院创伤一科，浙江金华 321017

基金项目:

浙江省医药卫生科技计划项目 2020KY1018

详细信息

通讯作者:
王晓成，E-mail: tiger637@163.com

中图分类号: R684.3 R687.4
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- 文章访问数: 14
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- 被引次数: 0
出版历程
- 收稿日期: 2024-04-10
- 网络出版日期: 2025-01-20

Clinical study of upper fibular osteotomy combined with arthroscopic debridement in the treatment of medial compartment osteoarthritis of knee joint

Department of Orthopedics, Jinhua Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang 321017, China

摘要

摘要: 目的运用膝关节不均匀沉降理论为膝关节骨性关节炎(KOA)外科治疗提供新思路，本研究旨在探讨与单纯关节镜清理术相比，腓骨上段截骨术联合关节镜清理术治疗膝关节内侧间室骨性关节炎是否具备临床优势。方法收集2021年1月—2023年6月于金华市中医医院完成治疗且术后随访≥6个月的125例膝关节内侧间室骨性关节炎患者相关资料，依据治疗方式不同分为对照组(单纯关节镜清理术，72例)和研究组(腓骨上段截骨联合关节镜清理术，53例)，比较2组股骨胫骨角(FTA)、胫骨关节间隙角、膝关节活动度(ROM)、美国特种外科医院(HSS)评分和膝关节滑液白介素-6(IL-6)、白介素-1β(IL-1β)变化，并统计手术相关并发症发生率。结果术后6个月，研究组FTA[(180.21±1.90)° vs.(182.89±1.75)°]、胫骨关节间隙角[(1.58±0.37)° vs.(3.09±0.61)°]和膝关节滑液IL-6、IL-1β水平均低于对照组，ROM[(91.23±7.05)° vs.(82.86±6.72)°]、HSS评分[(74.50±7.25)分vs.(65.12±6.37)分]均高于对照组(P＜0.05)，膝关节功能改善效果优于对照组(P＜0.05)。2组并发症发生率差异无统计学意义(P＞0.05)。结论腓骨上段截骨术联合关节镜清理术是治疗膝关节内侧间室骨性关节炎的有效方案，能明显改善患者的下肢力量，减轻膝关节炎性损伤和提高活动功能，且安全性较好。
- 膝关节内侧间室骨性关节炎 /
- 腓骨上段截骨术 /
- 关节镜清理术 /
- 膝关节功能
Abstract: Objective The theory of uneven settling of the knee joint provides a new idea for the surgical treatment of knee osteoarthritis (KOA). The objective of this study was to investigate the clinical advantages of superior fibular osteotomy combined with arthroscopic debridement in the treatment of medial compartment osteoarthritis of the knee joint compared to arthroscopic debridement alone. Methods The data of 125 patients with medial compartment osteoarthritis of the knee joint who completed treatment in Jinhua Hospital of Traditional Chinese Medicine from January 2021 to June 2023 and were followed up for ≥6 months were collected. According to different treatment methods, they were divided into the control group (72 cases with arthroscopic debridement alone) and the study group (53 cases with superior fibular osteotomy combined with arthroscopic debridement). The changes of femoral tibial angle (FTA), tibial joint space angle, knee range of motion (ROM), hospital for special surgery (HSS) score and synovial fluid interleukin-6 (IL-6) and interleukin-1β (IL-1β) were compared between the two groups, and the incidence of surgery-related complications were analyzed. Results Six months after surgery, the levels of FTA [(180.21±1.90)° vs. (182.89±1.75) °], tibial joint space angle [(1.58±0.37)° vs. (3.09±0.61) °] and IL-6 and IL-1β in synovial fluid of knee joint in the study group were lower than those in the control group. The ROM [(91.23±7.05)° vs. (82.86±6.72)°] and HSS scores [(74.50±7.25) points vs. (65.12±6.37) points] were higher than those of the control group (P < 0.05), and the improvement of knee joint function was better than that of the control group (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion Upper fibular osteotomy combined with arthroscopic debridement is an effective treatment for medial compartment osteoarthritis of the knee joint, which can significantly improve the lower limb force line, reduce inflammatory injury of the knee joint and improve mobility function, with good safety.
- Medial compartment osteoarthritis of knee joint /
- Upper fibula osteotomy /
- Arthroscopic debridement /
- Knee joint function

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图 1 膝关节内侧间室骨性关节炎患者围手术期图片

注：A~D为半月板损伤及半月板成形术的关节镜下图片；E~F为腓骨上段截骨前的X线片；G为术中截骨操作；H~I为截骨术后X线片。

Figure 1. Perioperative picture of a patient with medial ventricular osteoarthritis of knee joint

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表 1 2组膝关节内侧间室骨性关节炎患者相关资料比较

Table 1. Comparison of relevant data between the two groups of patients with medial compartment osteoarthritis of knee joint

组别	例数	性别 (男/女，例)	年龄(x±s，岁)	BMI (x±s)	K-L分级(例)		手术时间 (x±s，min)	术中出血量 (x±s，mL)	住院时间 (x±s，d)
组别	例数	性别 (男/女，例)	年龄(x±s，岁)	BMI (x±s)	Ⅱ级	Ⅱ级以上	手术时间 (x±s，min)	术中出血量 (x±s，mL)	住院时间 (x±s，d)
对照组	72	39/33	61.58±9.26	24.41±2.26	30	42	71.87±12.50	42.76±9.13	6.51±1.02
研究组	53	28/25	62.03±8.87	24.60±2.23	21	32	84.01±15.81	45.01±10.24	6.47±1.10
统计量		0.022^a	0.235^b	0.401^b	0.053^a		4.793^b	1.293^b	0.209^b
P值		0.882	0.814	0.689	0.002		＜0.001	0.198	0.834
注：^a为χ²值, ^b为t值。

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表 2 2组膝关节内侧间室骨性关节炎患者FTA、胫骨关节间隙角、ROM比较(x±s，°)

Table 2. Comparison of FTA, tibial joint space angle, and ROM between the two groups of patients with medial ventricular osteoarthritis of knee [x±s, °]

组别	例数	FTA		胫骨关节间隙角		ROM
组别	例数	术前	术后6个月	术前	术后6个月	术前	术后6个月
对照组	72	183.24±1.87	182.89±1.75	3.12±0.58	3.09±0.61	75.24±6.40	82.86±6.72^b
研究组	53	183.16±2.01	180.21±1.90^b	3.13±0.60	1.58±0.37^b	75.08±6.38	91.23±7.05^b
统计量		0.229^a	10.237^c	0.094^a	14.386^c	0.138^a	23.014^c
P值		0.819	＜0.001	0.925	＜0.001	0.890	＜0.001
注：^a为t值, ^c为F值；与同组术前比较，^bP＜0.05。

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表 3 2组膝关节内侧间室骨性关节炎患者HSS评分及分级比较

Table 3. Comparison of HSS scores and grading between the two groups of patients with medial ventricular osteoarthritis of knee joint

组别	例数	HSS评分(x±s，分)		HSS评分分级 (优/良/中/差，例)
组别	例数	术前	术后6个月	HSS评分分级 (优/良/中/差，例)
对照组	72	55.63±5.39	65.12±6.37^b	7/20/35/10
研究组	53	56.01±6.02	74.50±7.25^b	10/31/10/2
统计量		0.371^a	18.359^c	19.691^d
P值		0.712	＜0.001	＜0.001
注：^a为t值，^c为F值，^d为Z值；与同组术前比较，^bP＜0.05。

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表 4 2组膝关节内侧间室骨性关节炎患者膝关节滑液IL-6、IL-1β比较(x±s，pg/mL)

Table 4. Comparison of IL-6 and IL-1β levles in synovial fluid of knee joint between the two groups of patients with medial ventricular osteoarthritis of knee joint (x±s, pg/mL)

组别	例数	IL-6		IL-1β
组别	例数	术前	术后6个月	术前	术后6个月
对照组	72	6.13±1.45	2.96±0.73^b	7.38±1.94	3.05±0.92^b
研究组	53	6.20±1.51	2.13±0.52^b	7.54±2.02	2.34±0.63^b
统计量		0.262^a	8.105^c	0.448^a	7.729^c
P值		0.794	＜0.001	0.655	＜0.001
注：^a为t值, ^c为F值；与同组术前比较，^bP＜0.05。

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