改良'V+L'型胫骨高位截骨+钢板螺丝钉内固定术治疗膝骨性关节炎并内翻畸形临床对照研究

摘要

Objective To explore the effect of improved "V+L" type tibial high osteotomy+ internal fixation with steel plate and screw for treating knee osteoarthritis (KOA) complicated with varus deformity. Methods From Jan-uary 2016 to September 2016, 40 patients with KOA and varus were selected from Department of Orthopaedics, the Bai Shi Orthopedic Hospital of Pengjiang District of Jiangmen City, which were divided into two groups using random num-ber table. The control group (20 cases) received conservative treatment, and the surgery group (20 cases) applied im-proved "V+L" type tibial high osteotomy+internal fixation with steel plate and screw. Before treatment and 3 months, 6 months after treatment, the curative effect was evaluated according to Lequesne index. Results The Lequesne index of patients with 1 month, 3 months and 6 months after treatment was respectively (12.57±1.71), (7.26±1.02), (3.19±0.24) in the surgery group, significantly lower than those before treatment and also significantly lower than the corresponding (15.62±2.93), (12.47±1.26), (11.52±0.93) in the control group (P<0.05). Three months after treatment, the knee buckling mobility of the load bearing position was (112.43±16.73)°, significantly higher than that before treatment and that in the control group, and unbend hysteresis for lack of degrees was (1.49±0.28)°, significantly lower than that before treatment and that in the control group (P<0.05). Conclusion Improved "V+L" type tibial high osteotomy+internal fixation with steel plate and screw in the treatment of KOA and varus deformity is easy to operate with significant curative effect, and can recover the function of the knee joint activities.%目的 探讨改良"V+L"型胫骨高位截骨+钢板螺丝钉内固定术治疗膝骨性关节炎(KOA)并内翻畸形的效果.方法 选择江门市蓬江区白石正骨医院创伤骨科2016年1～9月收治的40例KOA并内翻畸形患者,采用随机数表法分为两组,保守组20例于门诊给予药物保守治疗,手术组20例行改良"V+L"型胫骨高位截骨+钢板螺丝钉内固定术,治疗前、治疗后3个月和6个月采用国际骨关节炎的评分标准Lequesne指数评价疗效.结果 治疗后1、3、6个月手术组患者的Lequesne指数分别为(12.57±1.71)、(7.26±1.02)、(3.19±0.24),明显低于治疗前及保守组的(15.62±2.93)、(12.47±1.26)、(11.52±0.93),差异均有统计学意义(P<0.05);治疗后3个月手术组患者膝关节负重位下屈曲活动度为(112.43±16.73)°,明显高于治疗前和对照组,伸直滞缺度为(1.49±0.28)°,明显低于治疗前和对照组,差异均有统计学意义(P<0.05).结论 改良"V+L"型胫骨高位截骨+钢板螺丝钉内固定术治疗KOA并内翻畸形具有操作简便、疗效明显等优点,可恢复膝关节活动功能,是一种疗效确切的新术式.