Wang Chun-Jiu, Tian Xiang-Dong, Tan Ye-Tong, Xue Zhi-Peng, Zhang Wei, Li Xiao-Min, Liu Ang
Department of Minimally Invasive Surgery, the Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China.
Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China.
Zhongguo Gu Shang. 2024 Sep 25;37(9):886-92. doi: 10.12200/j.issn.1003-0034.20230948.
To explore clinical effect of distal tibial tubercle-high tibial osteotomy (DTT-HTO) in treating knee osteoarthritis (KOA) with medial meniscus posterior root tear (MMPRT).
A retrospective analysis was performed on 21 patients with varus KOA with MMPRT from May 2020 to December 2021, including 3 males and 18 females, aged from 49 to 75 years old with an average of (63.81±6.56) years old, the courses of disease ranged from 0.5 to 18.0 years with an average of(5.9±4.2) years, and 4 patients with grade Ⅱ, 14 patients with grade Ⅲ, and 3 patients with grade Ⅳ according to Kellgren-Lawrence;14 patients with type 1 and 7 patients with type 2 according to MMPRT damage classification. The distance of medial meniscusextrusion (MME) and weight-bearing line ratio (WBLR) of lower extremity were compared before and 12 months after operation. Visual analogue scale (VAS), Western Ontarioand and McMaster Universities (WOMAC) osteoarthritis index, and Lysholm knee score were used to evaluate knee pain and functional improvement before operation, 1, 6 and 12 months after operation, respectively.
Twenty-one patients were followed up for 12 to 18 months with an average of (13.52±1.72) months. MME distance was improved from (4.99±1.05) mm before operation to (1.87±0.76) mm at 12 months after operation (<0.05). WBLR was increased from (15.49±7.04)% before operation to (62.71±2.27)% at 12 months after operation (<0.05). VAS was decreased from (7.00±1.14) before operation to (2.04±0.80), (0.90±0.62) and (0.61±0.50) at 1, 6 and 12 months after operation. WOMAC were decreased from preoperative (147.90±9.88) to postoperative (103.43±8.52), (74.00±9.54) and (47.62±9.53) at 1, 6 and 12 months, and the difference were statistically significant (<0.05). Lysholm scores were increased from (46.04±7.34) before oepration to (63.19±8.93), (81.10±6.41) and (89.29±3.04) at 1, 6 and 12 months after operation(<0.05).
For the treatment of varus KOA with MMPRT, DTT-HTO could reduce medial meniscus protrusion distance, improve the ratio of lower limb force line, and effectively reduce knee pain and improve knee joint function.
探讨胫骨远端结节-高位胫骨截骨术（DTT-HTO）治疗伴内侧半月板后根撕裂（MMPRT）的膝骨关节炎（KOA）的临床疗效。
回顾性分析2020年5月至2021年12月间21例伴有MMPRT的膝内翻KOA患者，其中男性3例，女性18例，年龄49至75岁，平均（63.81±6.56）岁，病程0.5至18.0年，平均（5.9±4.2）年。根据Kellgren-Lawrence分级，Ⅱ级4例，Ⅲ级14例，Ⅳ级3例；根据MMPRT损伤分型，1型14例，2型7例。比较手术前后12个月下肢内侧半月板挤压距离（MME）和负重线比值（WBLR）。分别采用视觉模拟评分法（VAS）、西安大略和麦克马斯特大学（WOMAC）骨关节炎指数以及Lysholm膝关节评分评估术前、术后1、6和12个月时膝关节疼痛及功能改善情况。
21例患者随访12至18个月，平均（13.52±1.72）个月。MME距离由术前（4.99±1.05）mm改善至术后12个月时的（1.87±0.76）mm（<0.05）。WBLR由术前（15.49±7.04）%增至术后12个月时的（62.71±2.27）%（<0.05）。VAS评分由术前（7.00±1.14）降至术后1、6和12个月时的（2.04±0.80）、（0.90±0.62）和（0.61±0.50）。WOMAC评分由术前（147.90±9.88）降至术后1、6和12个月时的（103.43±8.52）、（74.00±9.54）和（47.62±9.53），差异均有统计学意义（<0.05）。Lysholm评分由术前（46.04±7.34）增至术后1、6和12个月时的（63.19±8.93）、（81.10±6.41）和（89.29±3.04）（<0.05）。
对于伴MMPRT的膝内翻KOA，DTT-HTO可减小内侧半月板突出距离，改善下肢力线比值，有效减轻膝关节疼痛并改善膝关节功能。
