近端腓骨截骨术治疗膝关节内侧间室骨关节炎：值得做吗？
Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?
作者信息
Huda Najmul, Islam Mir Shahid Ul, Kumar Hemant, Pant Ajay, Bishnoi Sandeep
机构信息
Department of Orthopaedics, Teerthankar Mahaveer Medical College and Research Centre Bagadpur, Uttar Pradesh, Moradabad, 244001 India.
出版信息
Indian J Orthop. 2020 Jun 9;54(Suppl 1):47-51. doi: 10.1007/s43465-020-00160-0. eCollection 2020 Sep.
BACKGROUND
Osteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis.
METHODS
Following approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren-Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12 months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1 year follow-up.
RESULTS
The mean age was 58.30 years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3 months follow-up it was 29.4 this was significantly better ( < 0.05) but the improvement was not significant at subsequent follow-up visits. Similarly the VAS scores also showed significant improvement at 3 months, but not at 6 and 12 months follow-up. There was no significant improvement in the femoro-tibial angle (FTA) at 1 year follow-up.
CONCLUSION
The study highlights that both the VAS scores and WOMAC scores were significantly better at 3 months after surgery. However these did not show any significant improvement at 6 and 12 months. It does not change the alignment of knee at one year follow-up. The authors conclude that proximal fibular osteotomy provides only short-term relief in patients of medial compartment knee osteo-arthritis.
背景
膝关节骨关节炎是老年患者膝关节疼痛的重要原因之一，是一种使人衰弱的疾病。它常导致膝关节内翻畸形。对于这种进行性膝关节疾病有多种治疗选择。近端腓骨截骨术（PFO）是一种新颖但简单的手术，用于缓解内侧间室膝关节骨关节炎的症状。本研究旨在评估该手术是否能改善内侧间室膝关节骨关节炎患者的症状、功能和肢体对线情况。
方法
经机构审查委员会批准后，这项前瞻性研究纳入了42例（56膝）Kellgren-Lawrence分级为II级和III级的内侧间室膝关节骨关节炎患者，并接受了近端腓骨截骨术。术前以及术后3个月、6个月和12个月随访时，通过视觉模拟量表（VAS）评分和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分进行临床评估，以评估疼痛和功能改善情况。术前以及术后1年随访时，通过测量股胫角（FTA）进行放射学评估。
结果
平均年龄为58.30岁。女性30例，男性12例。术前平均WOMAC评分为87.3，术后3个月为29.4，改善显著（<0.05），但在随后的随访中改善不显著。同样，VAS评分在术后3个月也有显著改善，但在术后6个月和12个月随访时没有改善。术后1年随访时股胫角（FTA）没有显著改善。
结论
该研究强调，术后3个月时VAS评分和WOMAC评分均显著改善。然而，在术后6个月和12个月时这些评分没有显示出任何显著改善。术后1年随访时膝关节对线没有改变。作者得出结论，近端腓骨截骨术仅能为内侧间室膝关节骨关节炎患者提供短期缓解。
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