不同目标力线设定对开放性楔形胫骨高位截骨术治疗膝关节骨性关节炎疗效的影响

目的:探讨开放性楔形胫骨高位截骨术(OWHTO)中采用不同目标力线对单间室膝关节骨性关节炎(KOA)疗效的影响。方法:回顾性分析本院收治的2016年9月～2018年9月采用OWHTO治疗单间室KOA患者41例的临床资料,根据不同目标力线分为固定力线组和个体化力线组,固定力线组19例患者采用统一调目标力线至Fujisawa点治疗,个体化力线组22例根据术中关节软骨Outerbridge分级、个体化调定目标力线治疗,对比两组术前及术后1.5个月、3个月、6个月、12个月的疼痛视觉模拟评分(VAS)及美国特种外科医院膝关节(HSS)评分变化,并对比术前和12个月时MRI及关节镜影像。结果:术后所有患者VAS评分、HSS评分均较术前改善(P0.05),其中个体化力线组术后1.5个月、3个月时VAS评分优于固定力线组,差异有统计学意义(P0.05)。MRI及关节镜显示两组患者均有不同程度软骨再生。结论:采用OWHTO治疗单间室KOA,根据患者不同软骨磨损情况制定个体化目标力线方案有利于患者早期疼痛的改善,但其长期功能的恢复及软骨再生与固定力线方案无明显差异。

The Effect of Different Target Force Lines for Open Wedge High Tibial Osteotomy in Knee Osteoarthritis Treatment

ABSTRACT Objective: To investigate the open wedge high tibial osteotomy(OWHTO) to treat the single joint compartment knee osteoarthritis(KOA) affected by different target force lines. Methods: The clinical data of 41 patients with single joint compartment KOA treated with OWHTO from September 2016 to September 2018 were retrospectively analyzed, it can be divided into fixed force line group and individual force line group according to different target force lines, 19 patients In the fixed force line group were uniformly adjusted from the target force line to the Fujisawa point, the Outerbridge of articular cartilage was used in 22 patients in the individual force line group and seted the target force line individually, compared the Visual analogue scale (VAS) scores and the Hospital for special surgery(HSS) knee scores changes of the two groups before operation and 1.5 months, 3 months, 6 months, 12 months follow-up after operation, then compared the MRI and arthroscopic images of two groups before operation and 12 months after operation. Results: All patients'' VAS scores, HSS scores were improved than before operation(P<0.05), the VAS score of the individual force line group better than that of the fixed force line group in 1.5 months and 3 months after operation, the difference was statistically significant(P<0.05). MRI and arthroscopy pictures showed that there was different degrees of cartilage regeneration in the patients of two groups. Conclusion: Adopt OWHTO to treat the single joint compartment KOA, the individualized target force line scheme is beneficial to the early improvement of patients'' pain according to different cartilage wear conditions of patients, but there is no significant difference between the long-term functional recovery, cartilage regeneration and the method of fixed force line.