余晓武 童肖广

【摘要】 目的：探讨腓骨截骨在治疗内侧疼痛膝关节骨性关节炎中的应用效果。方法：选取81例内侧疼痛膝关节骨性关节炎患者，行择期腓骨截骨手术。观察患者的手术、并发症、住院情况，于术前、术后3 d、术后1个月、术后3个月进行X线拍片，观察内侧间隙增宽程度，进行视觉模拟（VAS）疼痛评分，采用AKS评分评价患者的膝关节功能。结果：81例手术均成功，无腓浅神经损伤和下肢静脉血栓形成，术后并发症发生率为4.94%。术后3 d、1个月、3个月时患者的膝关节内外侧间隙高度比均大于术前（P<0.05）。术后1个月、3个月时患者的VAS疼痛评分均小于术前（P<0.05）。术后1个月、3个月时患者的AKS评分均大于术前（P<0.05）。结论：以内侧疼痛为主要表现的膝关节骨性关节炎，保守治疗无效时采用腓骨截骨手术治疗，增宽膝关节内侧间隙，治疗效果良好，患者疼痛减轻，膝关節功能明显改善。

【关键词】 膝关节 骨性关节炎 腓骨截骨 疼痛 膝关节功能

doi：10.14033/j.cnki.cfmr.2019.30.066 文献标识码 B 文章编号 1674-6805（2019）30-0-03

[Abstract] Objective： To explore the effect of fibula osteotomy in the treatment of medial pain knee osteoarthritis. Method： Eighty-one patients with medial pain and knee osteoarthritis were selected for selective fibular osteotomy. Operations， complications and hospitalization were observed. X-ray films were taken before operation， 3 days after operation， 1 month after operation and 3 months after operation to observe the extent of medial space widening. Visual analogue （VAS） pain score was performed. AKS score was used to evaluate knee joint function. Result： All 81 cases were successfully operated without superficial peroneal nerve injury and lower extremity venous thrombosis. The incidence of complications was 4.94%. At 3 days， 1 month and 3 months after operation， the height ratio of the knee joint gap between the inside and outside was higher than that before operation （P<0.05）. At 1 month and 3 months after operation， the VAS pain score was lower than that before operation （P<0.05）. The AKS scores of patients at 1 month and 3 months after operation were higher than those before operation （P<0.05）. Conclusion： Osteoarthritis of knee joint mainly manifested by medial pain. When conservative treatment is ineffective， fibular osteotomy is used to widen the medial gap of knee joint. The therapeutic effect was good， the pain of patients is alleviated， and the function of knee joint is obviously improved.

[Key words] Knee joint Osteoarthritis Fibular osteotomy Pain Knee joint function

First-authors address： Qichun Peoples Hospital， Qichun 435300， China

膝关节骨性关节炎是膝关节的局部损伤及炎症，通常是由慢性劳损引起，造成关节软骨面下骨板反应性骨损[1]。该病是中老年人的常见疾患，我国人群整体患病率可达9.56%[2]，在60岁以上老年人中高达78.5%[3]，患者初期表现为活动时疼痛，持续进展到后期则关节肿胀、畸形，日常活动严重受限。有研究表示，膝关节炎主要累及内侧间隙，多以内侧疼痛为主要表现，临床上常见治疗方案为保守治疗，如推拿、理疗、药物治疗等，但部分长期患者效果不佳，而膝关节置换术尽管效果最好，但手术创伤大、医疗费用高昂[4]。综合性学科研究发现，该病的主要机理为骨质疏松导致的膝关节不均匀沉降[5]。基于该理论，近年来腓骨截骨术逐渐应用于该病，对于内侧间隙受累疼痛的患者有着良好的效果。目前我国对于腓骨截骨术应用的近期、远期效果观察的研究较少，故本研究探讨腓骨截骨对于改善患者近期症状和远期膝关节功能，现报道如下。……