胫骨结节远端单平面截骨术治疗膝内侧骨性关节炎△

Single-plane distal tibial tuberosity high tibial osteotomy for medial knee osteoarthritis

摘要:

[目的] 探讨胫骨结节远端单平面截骨术 （distal tibial tuberosity-high tibial osteotomy, DTT-HTO） 治疗膝内侧骨关节炎的疗效。[方法] 回顾性分析 2021 年 3 月—2023 年 3 月本院行 DTT-HTO 治疗的 70 例膝内侧骨关节炎患者的临床资料，评价临床及影像资料。[结果]70 例患者均顺利完成手术，未发生严重不良反应及并发症。所有患者均获得随访，随访时间平均 （19.5±3.7）个月，患者下肢全负重时间平均（58.0±5.2）d。随术后 1、8 周及末次随访的时间推移，术区痛 VAS 评分 [(4.8±0.9), (0.5±0.8), (0.1±0.3), P＜0.001] 和膝痛 VAS 评分 [(6.9±0.9), (2.4±0.7), (1.4±0.7), (0.7±0.6), P＜0.001] 显著减少。而 HSS 评分 [(54.0±9.2), (64.9±3.7), (82.0±4.1), (86.5±4.0), P＜0.001] 和 Lysholm 评分 [(45.8±6.3), (59.5±3.9), (83.5±4.1), (89.6±3.6), P＜0.001] 均显著改善。影像方面，随术前，术后 1、8 周及末次随访的时间推移，下肢力线比率、胫股角、胫骨近端内侧角、胫骨平台后倾角、K-L 分级均显著改善（P＜0.001）。[结论]DTT-HTO 治疗膝内侧骨关节炎疗效显著，术后早期主要疼痛来源为术区疼痛，应进行针对性康复锻炼和治疗。

Abstract:

[Objective] To investigate the clinical efficacy of single-plane distal tibial tuberosity high tibial osteotomy (DTT-HTO) in the treatment of medial knee osteoarthritis. [Methods] A retrospective research was done on 70 patients who had medial knee osteoarthritis treated by DTT-HTO in our hospital from March 2021 to March 2023. The clinical and imaging documents were evaluated. [Results] All the 70 patients had DTT-HTO performed successfully without serious adverse reactions and complications. All patients were followed up for an average of (19.5±3.7) months, and resumed the full weight-bearing activity in an average of (58.0±5.2) days. With time elapsed 1, 8 weeks and the last follow-up, the local pain VAS score [(4.8±0.9), (0.5±0.8), (0.1±0.3), P＜0.001] and knee pain VAS score [(6.9±0.9), (2.4±0.7), (1.4±0.7), (0.7±0.6), P＜0.001] were significantly declined, while the HSS score [(54.0±9.2), (64.9±3.7), (82.0±4.1), (86.5±4.0), P＜0.001] and Lysholm score [(45.8±6.3), (59.5±3.9), (83.5±4.1), (89.6±3.6), P＜0.001] were significantly increased. Radiographically, the weight-bearing alignment ratio (WBAR), femorotibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and K-L scale were significantly improved over time preoperatively, 1, 8 weeks postoperatively and at the last follow-up (P＜0.001). [Conclusion] This singleplane DTT-HTO is an effective treatment for medial knee osteoarthritis. The main source of early postoperative pain comes from operative area, and targeted rehabilitation exercise and treatment should be carried out.