关节镜联合胫骨高位截骨治疗伴膝内翻的中老年患者内侧半月板退变性损伤

doi:10.3877/cma.j.issn.2096-0263.2020.02.007

目的

探讨关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤的早期疗效。

方法

回顾性分析2014年1月至2015年1月，西南医科大学附属医院骨关节外科收治的伴膝内翻的内侧半月板退变性损伤患者26例，采取关节镜联合胫骨高位截骨的手术方式进行治疗。其中男性18例（18膝），女性8例（8膝）：年龄43~58岁，平均（49±6）岁。所有患者均为内侧半月板退变性损伤且伴有膝内翻，均行内侧撑开胫骨高位截骨，关节镜下半月板部分切除术缓解疼痛。测量下肢机械轴通过胫骨平台的相对位置、股胫角、胫骨平台后倾角；末次随访时评估膝关节各间室骨关节炎进展情况，采用Lysholm评分、美国特种外科医院（HSS）评分和Tegner膝关节运动评分评价膝关节功能，采用视觉模拟疼痛评分（VAS）评价疗效。

结果

本组26例患者均获随访，随访时间为1.0~2.8年，平均为（1.6±0.5）年。未发现感染、下肢深静脉血栓形成、骨不愈合或延迟愈合等并发症。下肢机械轴通过胫骨平台的相对位置由术前（21.2±3.8）%改善至（59.5±1.7）%，股胫角由术前的（172±4）°改善至（179±4）°，差异均有统计学意义（t=14.257，P<0.05；t=10.572，P<0.05）。术前胫骨平台后倾角为（7.5±2.2）°，术后为（7.9±1.9）°，差异无统计学意义（t=1.628，P>0.05）。末次随访时，患者Lysholm评分、HSS评分、Tegner评分、VAS评分均较术前明显改善，差异有统计学意义（t=7.684，P<0.05；t=16.521，P<0.05；t=6.284，P<0.05；t=12.359，P<0.05）。

结论

关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤，能够有效改善下肢力线和缓解关节疼痛，早期临床疗效满意。

关键词: 膝内翻, 胫骨高位截骨, 半月板退变性损伤

Objective

To explore the short-term effectiveness of arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint.

Methods

A retrospective study was performed on 26 patients with degenerative tears of the medial meniscus with varus deformity of knee joint who underwent arthroscopic combined with high tibial osteotomy that received in the Affiliated Hospital of Southwest Medical University from January 2014 to January 2015. There were 18 males (18 knees) and 8 females (8 knees), aged 43-58 years (mean, 49±6 years). All the patients were degenerative tears of the medial meniscus combined with varus deformity of knee joint. All patients underwent high tibial osteotomy, and the partial menisectomy was adjusted to relieve pain. Evaluated the position of weight bearing line, femoral tibial angle and posterior tibial slope. The Lysholm scores, Hospital for Special Surgery (HSS) score, and Tegner knee activity (Tegner) score were used to estimate knee joint function, while the visual analogue scale (VAS) scores were used to estimate the efficacy.

Results

Twenty-six patients in this group were all followed up, and the follow up time was 1.0-2.8 years, average (1.6±0.5) years. No complications of infection, deep vein thrombosis, nonunion or delayed union was observed. The weight bearing line was corrected from (21.3±3.8)% preopera tively to (59.5±1.7)% postoperatively. The femoraltibial angle was (172±4)° preoperatively and improved to (179±4)° postoperatively, and the differences were all statistically significant (t=14.257, P<0.05; t=10.572, P<0.05). The tibial slope was increased from (7.5±2.2)° preoperatively to (7.9±1.9)° postoperatively, showing no significant differences (t=1.628, P>0.05). At last follow-up, Lysholm score, HSS score, Tegner score, and VAS were significantly improved than preoperative ones, showing significant differences (t=7.684, P<0.05; t=16.521, P<0.05; t=6.284, P<0.05; t=12.359, P<0.05).

Conclusion

Arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint can significantly improve the alignment of lower extremity and relieve pain, and can get a good short term efficacy.

Key words: Varus of knee, High tibial osteotomy, Degenerative tears of the meniscus

表1 26例（26膝）伴有膝内翻的内侧半月板退变性损伤中老年患者手术前后影像学测量以及临床疗效评价指标比较（±s）

时间	股胫角（°）	胫骨平台后倾角（°）	下肢力线通过胫骨平台相对位置(%)	Lysholm评分	HSS评分	Tegner评分	VAS评分
术前	172±4	7.5±2.2	21.3±3.8	52±6	54±6	3.5±0.6	7.2±1.4
末次随访	179±4	7.9±1.9	59.5±1.7	90±5	87±6	2.4±0.6	1.6±0.9
统计值	t=10.572	t=1.628	t=14.257	t=7.684	t=16.521	t=6.284	t=12.359
P值	<0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表1 26例（26膝）伴有膝内翻的内侧半月板退变性损伤中老年患者手术前后影像学测量以及临床疗效评价指标比较（±s）

时间	股胫角（°）	胫骨平台后倾角（°）	下肢力线通过胫骨平台相对位置(%)	Lysholm评分	HSS评分	Tegner评分	VAS评分
术前	172±4	7.5±2.2	21.3±3.8	52±6	54±6	3.5±0.6	7.2±1.4
末次随访	179±4	7.9±1.9	59.5±1.7	90±5	87±6	2.4±0.6	1.6±0.9
统计值	t=10.572	t=1.628	t=14.257	t=7.684	t=16.521	t=6.284	t=12.359
P值	<0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

图1~7 患者，女性，48岁，右膝内侧半月板后角水平状撕裂伴膝内翻；图1术前双下肢全长X线片；图2~3术前MRI；图4~5术中关节镜图像（术中关节镜下示内侧半月板后角水平状撕裂）；图6术后1年双下肢全长X线片及测量下肢机械轴通过胫骨平台的位置示意图，ab为胫骨平台的宽度，c点为下肢机械轴经过胫骨平台的交点，bc/ab为力线经过胫骨平台的相对位置；图7术后1年侧位X线片

图9 胫骨平台后倾角的测量：胫骨骨干解剖轴的垂线与胫骨平台切线间的夹角

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Arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint in the middle aged patient

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Arthroscopic combined with high tibial osteotomy to treat degenerative tears of the medial meniscus with varus deformity of knee joint in the middle aged patient