本文選題：膝骨性關節(jié)炎 + 內(nèi)側(cè)間室��； 參考：《廣西中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過前瞻性隨機分組試驗研究,探討腓骨近端截骨術對比膝關節(jié)鏡有限清理術在治療早中期內(nèi)側(cè)間室受累型膝骨性關節(jié)炎的短期臨床療效差異。方法:納入自2015年1月至2016年12月在廣西骨傷醫(yī)院骨關節(jié)科住院行手術治療的內(nèi)側(cè)間室受累型膝骨性關節(jié)炎的患者共40例,對符合標準的患者按隨機數(shù)字分組方法將患者分成A、B兩組,每組各納入20例,其中A組患者行單純腓骨近端截骨術;B組患者行膝關節(jié)鏡下有限清理術。對兩組患者均進行術前及術后1個月、3個月、6個月、12個月隨訪觀察,隨訪內(nèi)容包括膝關節(jié)功能HSS、KSS評分和VAS疼痛評分以及統(tǒng)計術后并發(fā)癥情況,并通過測量X線下膝關節(jié)內(nèi)側(cè)間隙及下肢股脛角(FTA),比較膝關節(jié)影像學改變。結(jié)果:共納入的27例符合標準的病例,A組12例,15膝;B組15例,18膝。兩組患者均獲得了12-20個月的隨訪,A組平均(15.91±2.61)個月,B組平均(16.53±3.04)個月。兩組患者術后均未發(fā)生術口或關節(jié)內(nèi)感染、下肢靜脈血栓、神經(jīng)損傷等并發(fā)癥。組內(nèi)差異比較:兩組患者的術后HSS、KSS評分較術前增高,VAS評分較術前低,差異具有統(tǒng)計學意義(P0.05);A組術后FTA和內(nèi)側(cè)關節(jié)間隙較術前分別增加(3.3±1.0)°、(1.53±0.50)mm,差異有統(tǒng)計學意義;B組術前與術后的FTA、內(nèi)側(cè)關節(jié)間隙比較均無統(tǒng)計學意義(P0.05)。組間對比:1.VAS:在術后第1個月,A組VAS評分高于B組,第3個月兩組接近,而在第6、12月時A組VAS評分均低于B組,差異具有統(tǒng)計學意義(P0.05)。2.HSS:術后第1月,A組與B組對比無統(tǒng)計學意義,在第3、6、12月A組HSS評分均高于B組,差異有統(tǒng)計學意義。3.KSS:兩組在術后第1、3月評分接近,無統(tǒng)計學意義,在第6、12月A組評分均高于B組,差異具有統(tǒng)計學意義(P0.05)。結(jié)論:在短期療效上,單純腓骨近端截骨術和膝關節(jié)鏡有限清理手術在治療早中期膝內(nèi)側(cè)間室型骨性關節(jié)炎均具有良好的療效,而隨著時間的的推移,腓骨近端截骨術相對來說能較好地減輕患者疼痛,改善膝關節(jié)功能,療效優(yōu)于關節(jié)鏡手術,值得在臨床推廣應用。
[Abstract]:Objective: to investigate the short-term clinical efficacy of proximal fibula osteotomy compared with limited debridement of knee arthroscopy in the treatment of early and middle medial compartment involvement knee osteoarthritis. Methods: from January 2015 to December 2016, 40 patients with medial compartment involved knee osteoarthritis were admitted to the Department of Orthopedics and Joint of Guangxi Orthopedic Hospital. Patients who met the criteria were randomly divided into two groups: group A (n = 20) and group B (n = 20). Group A received simple proximal fibula osteotomy and group B underwent limited debridement under knee arthroscopy. The patients in both groups were followed up for 1 month, 3 months, 6 months and 12 months before and after operation. The follow-up included HSS KSS score, VAS pain score and postoperative complications. The radiographic changes of the knee joint were compared by measuring the medial space of the knee joint and the femoral tibial angle of the lower extremity. Results: a total of 27 cases were included in group A (12 cases with 15 knees) and group B (15 cases with 18 knees). Two groups of patients were followed up for 12 to 20 months, with an average of 15.91 鹵2.61 months in group A and 16.53 鹵3.04 months in group B. There were no complications such as intraarticular infection, venous thrombosis and nerve injury in both groups. Comparison of intra-group differences: the postoperative HSS-KSS scores in the two groups were higher than those in the preoperative patients and the VAS scores were lower than those before the operation. The difference was statistically significant in the postoperative FTA and medial articular space in group A (3.3 鹵1.0) 擄and 1.53 鹵0.50 mm, respectively. There was no significant difference in FTAs between pre-and post-operation in group B, and there was no significant difference in the medial articular space between group B and group B (P 0.05). VAS: the VAS score of group A was higher than that of group B at the first month after operation, but the VAS score of group A was lower than that of group B at the 6th and 12th month after operation. The difference was statistically significant (P 0.05). 2. HSS: there was no significant difference between group A and group B in the first month after operation, but the scores of VAS in group A were lower than those in group B at 6 and 12 months after operation. The score of HSS in group A was higher than that in group B in the 3rd month and 12th month, the difference was statistically significant. 3. KSS: the scores of group A were higher than that of group B at the 1st and 3rd month after operation, but the score of group A was higher than that of group B in the 6th and 12th months, the difference was statistically significant (P 0.05). Conclusion: simple proximal fibula osteotomy and limited debridement of knee arthroscopy are effective in the treatment of medial ventricular osteoarthritis of the knee in early and middle period, but with the passage of time. Proximal fibula osteotomy can relieve pain and improve knee joint function, which is worth popularizing in clinic.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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