目的:评价并比较腓骨近端截骨术(PFO)治疗上腓骨曲度与非曲度内侧膝骨性关节炎(KOA)的临床和影像学结果。
方法:进行回顾性队列研究。2016年1月至2017年1月,共有51例(男9例,女42例)在河北医科大学第三医院接受PFO手术的内侧KOA患者纳入研究,平均年龄为63.7岁(范围48-79岁)。将患者分为两组,即曲率组(28例患者,6名男性和22名女性,年龄62.6±7.7岁)和非曲率组(23例患者,三只雄性和二十只雌性,年龄64.5±7.6岁)。记录并分析两组患者的围手术期参数和Kellgren-Lawrence分类,分别。所有患者均于术后1、3、6、12个月随访,然后从术后第二年开始每6个月。采用标准问卷调查的电话调查,包括视觉模拟量表(VAS)评分和特殊外科医院(HSS)评分系统,用于评估术后临床结果。放射学结果使用股癣角度(FTA)进行评估,髋-膝-踝角度(HKA),两组胫骨内侧平台(MTP)沉降值。
结果:曲率组和非曲率组的平均随访时间分别为34.8±6.1和33.9±5.4个月,分别。两组的人口统计学数据在患者人数方面无显著差异,年龄,体重指数(BMI),性别,KOA侧,Kellgren-Lawrence分类(P>0.05)。曲率组和非曲率组1个月时VAS评分分别为(3.53±1.62vs3.68±1.43,3个月时3.46±0.79vs3.57±0.66,6个月时为2.43±0.88和2.83±0.94,两者P>0.05),术后12个月有显著性差异(1.54±0.72vs2.03±0.85,24个月时为1.04±0.69vs1.74±0.75,均P<0.05)。曲率组和非曲率组的HSS评分在1个月时分别为(79.67±5.14vs78.25±6.37,3个月时84.65±3.76vs83.18±3.64,6个月时为86.27±3.13vs85.49±3.25,两者P>0.05),而术后12个月发现显着差异(12个月时90.64±4.32vs87.71±5.63,在24个月时为92.93±2.07vs90.06±2.08,均P<0.05)。此外,曲率组的FTA和沉降值低于非曲率组(177.18±1.52vs178.35±1.86和5.29±1.74vs6.49±2.09,均P<0.05),而HKA高于非曲率组(175.32±2.34vs173.83±2.64,P<0.05)。
结论:腓骨上弯曲的内侧KOA患者是PFO手术的最佳手术指征,有了缓解疼痛的优势,更好的功能恢复,和对准校正。
OBJECTIVE: To evaluate and compare the clinical and radiographic outcomes of proximal fibular osteotomy (PFO) in treating medial knee osteoarthritis (KOA) patients with upper fibular curvature and non-curvature.
METHODS: A retrospective cohort study was performed. From January 2016 to January 2017, a total of 51 patients (nine males and 42 females) at a mean age of 63.7 years (range 48-79 years) with medial KOA who underwent PFO procedure at the Third Hospital of Hebei Medical University were included in the study. The patients were divided into the two groups, namely curvature group (28 patients, six males and 22 females, aged 62.6 ± 7.7 years) and non-curvature group (23 patients, three males and 20 females, aged 64.5 ± 7.6 years). Perioperative parameters and Kellgren-Lawrence classification were recorded and analyzed in the two groups, respectively. All patients were followed up at 1, 3, 6, and 12 months at the first year of post-operation, and then every 6 months from the second year of post-operation. A telephone survey with standard questionnaire survey, including Visual Analog Scale (VAS) score and Hospital for Special Surgery (HSS) scoring system, was used to evaluate postoperative clinical outcomes. Radiological results were assessed using the femorotibial angle (FTA), hip-knee-ankle angle (HKA), and settlement value of medial tibial platform (MTP) in the two groups.
RESULTS: The average follow-up periods of the curvature group and the non-curvature group were 34.8 ± 6.1 and 33.9 ± 5.4 months, respectively. There were no significant differences between the two groups of demographic data in terms of number of patients, age, body mass index (BMI), gender, KOA side, and Kellgren-Lawrence classification (P > 0.05). The VAS scores of the curvature group and non-curvature group were (3.53 ± 1.62 vs 3.68 ± 1.43 at 1 month, 3.46 ± 0.79 vs 3.57 ± 0.66 at 3 months, and 2.43 ± 0.88 vs 2.83 ± 0.94 at 6 months, both P > 0.05), while significant differences were found from 12 months post-operation (1.54 ± 0.72 vs 2.03 ± 0.85 at 12 months, and 1.04 ± 0.69 vs 1.74 ± 0.75 at 24 months, both P < 0.05). The HSS scores of the curvature group and non-curvature group were (79.67 ± 5.14 vs 78.25 ± 6.37 at 1 month, 84.65 ± 3.76 vs 83.18 ± 3.64 at 3 months, and 86.27 ± 3.13 vs 85.49 ± 3.25 at 6 months, both P > 0.05), while significant differences were found from 12 months post-operation (90.64 ± 4.32 vs 87.71 ± 5.63 at 12 months, and 92.93 ± 2.07 vs 90.06 ± 2.08 at 24 months, both P < 0.05). In addition, the FTA and settlement value of the curvature group were lower than the non-curvature group (177.18 ± 1.52 vs 178.35 ± 1.86, and 5.29 ± 1.74 vs 6.49 ± 2.09, both P < 0.05) while the HKA were higher than the non-curvature group (175.32 ± 2.34 vs 173.83 ± 2.64, P < 0.05) at the final follow-up.
CONCLUSIONS: Medial KOA patients with upper fibular curvature is an optimal surgical indication for PFO surgery, with the advantages of pain relief, better functional recovery, and alignment correction.