發(fā)布時間：2018-10-15 18:37

【摘要】：目的:評價腓骨近端截骨術(shù)治療早中期膝關(guān)節(jié)骨關(guān)節(jié)炎的初期療效。方法:回顧性收集2015年2月至2016年4月于山西大醫(yī)院骨科行腓骨近端截骨術(shù)治療的膝關(guān)節(jié)骨關(guān)節(jié)炎患者25例(27膝),于術(shù)前、術(shù)后3 d、3個月、6個月及1年記錄疼痛視覺模擬評分(VAS),美國膝關(guān)節(jié)協(xié)會評分(KSS),膝關(guān)節(jié)Lysholm評分,脛股角(FTA)、脛骨平臺內(nèi)翻角(TP-TSA)、髖-膝-踝角(HKA)、膝關(guān)節(jié)外側(cè)間室高度及腓骨頭外側(cè)結(jié)節(jié)到膝關(guān)節(jié)外側(cè)平臺距離的變化。結(jié)果:25例(27膝)患者均獲得1年隨訪;手術(shù)時間平均(64±27.5)min;術(shù)中出血量平均(16±9.5)ml;術(shù)后住院時間平均(4±1.2)d。與術(shù)前相比,術(shù)后3d、3月、6月及1年的VAS評分均降低(F=94.446,P0.05)、KSS臨床評分升高(F=69.820,P0.05)、KSS功能評分升高(F=58.363,P0.05)及膝關(guān)節(jié)Lysholm評分升高(F=51.410,P0.05),差異具有統(tǒng)計學意義。至末次隨訪時,24例(26膝)患者脛骨平臺內(nèi)翻角由術(shù)前(84.3±2.3)°增至術(shù)后(85.0±2.4)°,差異具有統(tǒng)計學意義(t=-2.112,P0.05);膝關(guān)節(jié)外側(cè)間室高度由術(shù)前(0.731±0.104)cm降至術(shù)后(0.665±0.960)cm,差異具有統(tǒng)計學意義(t=5.470,P0.05);腓骨頭外側(cè)結(jié)節(jié)到脛骨外側(cè)平臺距離由術(shù)前(3.370±0.411)cm增至術(shù)后(3.495±0.397)cm,差異具有統(tǒng)計學意義(t=-4.436,P0.05)。14例患者術(shù)前術(shù)后均拍攝雙下肢全長負重X線,測量髖-膝-踝角由術(shù)前(173.9±4.3)°增至術(shù)后(176.0±3.2)°,差異具有統(tǒng)計學意義(t=-3.640,P0.05);術(shù)前(180.0±2.9)°、術(shù)后(179.5±2.9)°的脛股角無變化(t=1.204,P0.05)。結(jié)論:腓骨近端截骨術(shù)治療早中期膝內(nèi)側(cè)間室骨關(guān)節(jié)炎的初期療效良好,能明顯緩解患者膝關(guān)節(jié)疼痛癥狀,改善膝關(guān)節(jié)功能,提高生活質(zhì)量。
[Abstract]:Objective: to evaluate the initial effect of proximal fibula osteotomy on early and middle stage knee osteoarthritis. Methods: Twenty-five patients (27 knees) with osteoarthritis of knee joint treated with proximal fibula osteotomy from February 2015 to April 2016 were retrospectively collected. Visual analogue score of pain was recorded at 3 days, 3 months, 6 months and 1 year after operation. (VAS), American knee Association score (KSS), knee joint Lysholm score were recorded. The changes of the tibial plateau varus angle (TP-TSA), the height of the lateral interventricular chamber of the knee joint of (HKA), and the distance from the lateral tubercle of the head of fibula to the lateral plateau of the knee joint in tibiofemoral angle (FTA),). Results: Twenty-five patients (27 knees) were followed up for 1 year, and the mean time of operation was (64 鹵27.5) min;, the average amount of bleeding was (16 鹵9.5) ml;, the average hospital stay was (4 鹵1.2) days. Compared with before operation, the VAS scores of 3 days, 3 months, 6 months and 1 year after operation were all decreased (FG 94.446%, P 0.05, P < 0.05, P < 0.05), and the scores of Lysholm of knee joint were significantly higher (P < 0.05) than those before operation (P 0.05, P 0.05), and the scores of Lysholm in knee joint were significantly higher than those before operation (P 0.05, P < 0.05) (P < 0.05). To the last follow-up, the tibial plateau varus angle increased from (84.3 鹵2.3) 擄to (85.0 鹵2.4) 擄after operation in 24 patients (26 knees), the difference was statistically significant (t = 2.112), the height of lateral interventricular chamber of knee joint decreased from (0.731 鹵0.104) cm before operation to (0.665 鹵0.960) cm, after operation (t = 5.4700.05), and the lateral ventricular height of knee joint decreased from (0.731 鹵0.104) cm to (0.665 鹵0.960) cm, after operation. The distance from the lateral tubercle to the lateral tibial plateau was increased from (3.370 鹵0.411) cm to (3.495 鹵0.397) cm, after operation. The hip knee ankle angle was measured from (173.9 鹵4.3) 擄before operation to (176.0 鹵3.2) 擄after operation, the difference was statistically significant (t _ (3.640) P _ (0.05), the tibiofemoral angle of (180.0 鹵2.9) 擄before and (179.5 鹵2.9) 擄after operation had no change (t _ (1.204) P 0.05). Conclusion: proximal fibula osteotomy is effective in treating osteoarthritis of medial compartment of knee in early and middle period. It can obviously relieve the symptoms of knee joint pain, improve the function of knee joint and improve the quality of life.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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