Zhong Hehe, Jin Ying, Liu Xiuqi, Yang Jibin, Wu Shuhong, Liu Yi
Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Aug 15;36(8):969-975. doi: 10.7507/1002-1892.202204093.
To investigate the effectiveness of high tibial osteotomy (HTO) combined with arthroscopic surgery to treat medial compartment knee osteoarthritis (KOA) and secondary arthroscopic exploration to evaluate the outcome of cartilage and meniscus.
A clinical data of 57 patients with medial compartment KOA with varus deformity of lower extremities admitted between August 2014 and October 2018 were retrospectively analyzed. There were 23 males and 34 females with an average age of 51.2 years (range, 41-63 years). The disease duration ranged from 2 to 8 years, with an average of 4.7 years. The preoperative femorotibial angle was (179.86±4.69)°, the relative position of the lower limb mechanical axis passing through the tibial plateau was 24.21%±6.98%, and the posterior slope of the tibial plateau was (5.23±1.45)°. The Kellgren-Lawrence grade of knee joint was grade Ⅱ in 22 cases and grade Ⅲ in 35 cases. The preoperative Hospital for Special Surgery (HSS) score, Lysholm score, and visual analogue scale (VAS) score were 59.1±7.3, 48.8±7.6, and 6.2±1.1, respectively. Arthroscopic exploration was performed during the operation to record the articular cartilage degeneration in the weight-bearing area of the medial compartment (Outerbridge grade Ⅰ in 18 cases, grade Ⅱ in 30 cases, and grade Ⅲ in 9 cases) and the condition of the medial meniscus injury, and the corresponding treatment was performed. The coronal force line was adjusted according to the preoperative Kellgren-Lawrence grade of the knee joint during the operation. After operation, the relative position of the lower limb mechanical axis passing through the tibial plateau, the femorotibial angle, and the posterior slope of the tibial plateau were measured; the Kellgren-Lawrence grade of the knee joint was recorded; the Outerbridge grade of articular cartilage degeneration and the meniscus outcome were evaluated by combining with the MRI of the knee joint at 1 year after operation and the second arthroscopic exploration when the internal fixator was removed. The function and pain of the knee were evaluated by Lysholm score, HSS score, and VAS score.
All the 57 patients were followed up 36-58 months with an average of 42.1 months. Incisions healed by first intention, and no neurovascular injury, intraarticular or hinge fractures occurred during operation, and no postoperative complications such as deep vein thrombosis of lower limbs and internal fixation failure occurred. All the osteotomy sites healed at 3 months after operation. At 1 year after operation, the internal fixator was removed, and the second arthroscopic exploration showed that there were 15 cases of Outerbridge grade Ⅰ, 31 cases of grade Ⅱ, and 11 cases of grade Ⅲ in the weight-bearing area of the medial compartment, and there was no significant difference when compared with preoperative grade ( =31.992, =0.997); there was no cartilage degeneration in other compartments. Meniscus healing was seen in the injured meniscus, and no injury was seen in the normal meniscus. At last follow-up, there were 19 cases of Kellgren-Lawrence grade Ⅱ and 38 cases of grade Ⅲ, and there was no significant difference when compared with preoperative grade ( =49.049, =0.764). The relative position of the lower limb mechanical axis passing through the tibial plateau was 59.16%±2.87%, and the femorotibial angle was (171.54±3.39)°, which significantly improved when compared with those before operation ( <0.001). The posterior slope of the tibial plateau was (5.65±1.22)°, which was not significantly different from that before operation ( =-1.673, =0.096). The HSS score, Lysholm score, and VAS score were 82.3±7.7, 83.4±6.4, and 1.6±1.1 respectively, which were significantly different from those before operation ( <0.001).
HTO combined with arthroscopic surgery for medial compartment KOA with varus deformity of lower extremities can effectively improve the force line of lower extremities, relieve pain symptoms, and improve joint function, with satisfactory short-term effectiveness, and without significant progress in articular cartilage or meniscus injury after operation.
探讨高位胫骨截骨术（HTO）联合关节镜手术治疗膝关节内侧间室骨关节炎（KOA）的疗效，并通过二次关节镜探查评估软骨和半月板的预后。
回顾性分析2014年8月至2018年10月收治的57例伴有下肢内翻畸形的膝关节内侧间室KOA患者的临床资料。其中男性23例，女性34例，平均年龄51.2岁（范围41 - 63岁）。病程2至8年，平均4.7年。术前股骨胫骨角为（179.86±4.69）°，下肢机械轴通过胫骨平台的相对位置为24.21%±6.98%，胫骨平台后倾角为（5.23±1.45）°。膝关节Kellgren - Lawrence分级：Ⅱ级22例，Ⅲ级35例。术前美国特种外科医院（HSS）评分、Lysholm评分及视觉模拟评分（VAS）分别为59.1±7.3、48.8±7.6及6.2±1.1。术中进行关节镜探查，记录内侧间室负重区关节软骨退变情况（Outerbridge分级：Ⅰ级18例，Ⅱ级30例，Ⅲ级9例）及内侧半月板损伤情况，并进行相应处理。术中根据术前膝关节Kellgren - Lawrence分级调整冠状力线。术后测量下肢机械轴通过胫骨平台的相对位置、股骨胫骨角及胫骨平台后倾角；记录膝关节Kellgren - Lawrence分级；术后1年结合膝关节MRI及取出内固定器时二次关节镜探查评估关节软骨退变的Outerbridge分级及半月板预后。采用Lysholm评分、HSS评分及VAS评分评估膝关节功能及疼痛情况。
57例患者均获随访，随访时间36 - 58个月，平均42.1个月。切口均一期愈合，术中无神经血管损伤、关节内或铰链骨折发生，术后无下肢深静脉血栓形成、内固定失败等并发症发生。所有截骨部位术后3个月均愈合。术后1年取出内固定器，二次关节镜探查显示内侧间室负重区Outerbridge分级：Ⅰ级15例，Ⅱ级31例，Ⅲ级11例，与术前分级比较差异无统计学意义（=31.992，=0.997）；其他间室无软骨退变。损伤半月板可见愈合，正常半月板未见损伤。末次随访时，Kellgren - Lawrence分级：Ⅱ级19例，Ⅲ级38例，与术前分级比较差异无统计学意义（=49.049，=0.764）。下肢机械轴通过胫骨平台的相对位置为59.16%±2.87%，股骨胫骨角为（171.54±3.39）°，与术前比较明显改善（<0.001）。胫骨平台后倾角为（5.65±1.22）°，与术前比较差异无统计学意义（=-1.673，=0.096）。HSS评分、Lysholm评分及VAS评分分别为82.3±7.7、83.4±6.4及1.6±1.1，与术前比较差异有统计学意义（<0.001）。
HTO联合关节镜手术治疗伴有下肢内翻畸形的膝关节内侧间室KOA能有效改善下肢力线，缓解疼痛症状，改善关节功能，短期疗效满意，术后关节软骨及半月板损伤无明显进展。
