3种手术方式治疗内侧间室骨关节炎的疗效比较

Comparison of three surgical modalities in treatment of knee medial compartment osteoarthritis

关键词:  膝关节  骨关节炎  内侧间室  腓骨截骨术

Key words:  knee joint  osteoarthritis  medial compartment  proximal fibular osteotomy

摘要:

目的 比较腓骨近端截骨术、单髁关节置换术(unicompartmental knee arthroplasty, UKA))以及全膝关节置换术(total knee arthroplasty, TKA)治疗内侧间室骨关节炎的临床疗效。方法 收集2015年1月至2015年11月收治的手术治疗膝关节骨关节炎患者49例,其中全膝关节置换术15例,单髁关节置换术17例,腓骨近端截骨术17例,比较3组患者的手术时间、出血量、住院时间、住院费用以及手术疗效。结果 49例患者随访时间4～12个月。腓骨截骨组手术时间、出血量、住院时间以及住院费用少于TKA组和UKA组,差异有统计学意义(P＜0.05)；术前和术后,3组患者的HSS、VAS、KSS评分、膝关节活动度、胫股角组间比较,差异无统计学意义(P＞0.05),与术前相比,术后3组患者的HSS、VAS、KSS评分、膝关节活动度、胫股角均好转,差异有统计学意义(P＜0.05)。结论 腓骨截骨术在治疗内侧间室骨关节炎中可达到与TKA和UKA类似的近期疗效,有恢复快,住院时间短,费用低等特点,具备临床推广价值。

Abstract:

ObjectiveTo compare proximal fibular osteotomy (PFO),total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) in treatment of knee medial compartment osteoarthritis. Methods Forty nine patients with medial compartment osteoarthritis of the knee undergoing surgical treatment from January 2015 to November 2015 were enrolled for the analysis, including 17 patients treated with PFO, 17 with UKA and 15 with TKA. The operation time, intraoperative blood loss, length of hospital stay, medical cost and curative effect were compared among 3 groups. Results Patients were followed up for 4-12 months. The operation time, total blood loss, length of hospital stay and total medical cost in PFO group were significantly less than those in other two groups (P＜0.05). The HSS, VAS, KSS scores, range of motion and femorotibial angle were improved in all three groups after operation (P＜0.05); and there were significant differences in above indicators among three group after treatment (P＞0.05).Conclusion The short term efficacy of PFO, TKA and UKA are similar in treatment of medial compartment osteoarthritis of the knee; however, PFO has the advantages of fast recovery, lower cost and shorter hospitalization.