目的

探究单平面胫骨高位截骨术联合关节镜治疗中重度内翻型膝骨关节炎后胫骨内外侧平台后倾角（PTSA）的具体变化情况。

方法

回顾性分析2022年11月至2023年12月北京中医药大学第三附属医院治疗的62例中重度内翻型膝骨关节炎患者的病历资料。纳入标准：单侧内翻型膝骨关节炎且术后随访资料完整；排除标准：随访期间对侧膝关节行其他手术治疗；严重其他骨病；术肢并发二次损伤。所有患者均行单平面胫骨高位截骨术联合关节镜治疗。所有患者均完成手术并获得随访。参照Brazier测量方法中的后皮质线法，通过DIGIMIZER数字软件在术肢膝关节侧位X线片上，测量并评估手术前后不同时间节点的胫骨内外侧PTSA以及膝关节主动屈曲活动度。采用疼痛视觉模拟评分（VAS）、美国西安大略与麦克马斯特大学骨关节炎指数评分（WOMAC）、Lysholm评分评估手术前后不同时间节点的膝关节疼痛及功能情况。使用重复测量方差分析进行统计学分析。

结果

62例患者均获得随访，随访时间（12.5±0.5）个月。术前内侧PTSA角度为（9.3±1.4）°，术后1、6、12个月的内侧PTSA角度较术均前无明显变化，差异均无统计学意义（F=0.317，P>0.05）；术前外侧PTSA角度为（8.2±1.4）°，术后1、6、12个月的外侧PTSA角度较术前均无明显变化，差异均无统计学意义（F=0.096，P>0.05）。膝关节主动屈曲活动度由术前的（97±4）°，增加至术后1、6、12个月的（103±4）°、（112±4）°、（117±4）°，膝关节主动屈曲活动度较术前逐渐增加，各时间节点比较差异有统计学意义（F=314.984，P<0.05）。手术后1、6、12个月时的VAS评分、WOMAC评分以及Lysholm评分均较术前改善，各时间点比较差异有统计学意义（F=1012.288、822.450、673.422，均为P<0.05）。

结论

胫骨结节远端单平面截骨术联合关节镜能够缓解中重度内翻型膝骨关节炎的疼痛，改善膝关节功能，增大膝关节活动范围，且在短期内胫骨平台内外侧后倾角没有明显改变。

Objective

To explore the specific changes in the posterior tibial slope angle (PTSA)of medial and lateral sides after distal tibial tubercle-high tibial osteotomy combined with arthroscopy in the treatment of moderate to severe varus knee osteoarthritis.

Method

A total of 62 patients with moderate to severe varus knee osteoarthritis treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from November 2022 to December 2023 were retrospectively analyzed. Inclusion criteria: unilateral varus knee osteoarthritis with complete postoperative follow-up data. Exclusion criteria: other surgical treatment of the contralateral knee during follow-up; severe other bone diseases; the operative limb was complicated with secondary injury. All the patients were treated with distal tibial tubercle-high tibial osteotomy combined with arthroscopy. All the patients completed the operation and were followed up. Referring to the tibial posterior cortical line in Brazier measurement method, the posterior slope angle of the medial and lateral tibial plateau and the active flexion range of the knee joint at different time points before and after the operation were measured and evaluated by DIGIMIZER digital software on the lateral X-ray film of the surgical knee joint.Pain visual analogue scale (VAS), Western Ontario and McMaster University osteoarthritis index (WOMAC)and Lysholm score were used to evaluate the knee pain and function at different time points before and after operation. Statistical analysis was performed using repeated measurement analysis of variance.

Results

All 62 patients were followed up for (12.5±0.5) months.The medial PTSA was (9.3±1.4)° before operation, and there was no significant change in the medial PTSA at one month, six and 12 months after operation compared with that before operation (F=0.317, P>0.05). The preoperative lateral PTSA was (8.2±1.4)°, and there was no significant change in the lateral PTSA at one month, six and 12 months after operation when compared with that before operation (F=0.096, P>0.05). The knee active flexion range of motion increased from (97±4)°before operation to (103±4)°, (112±4)°, (117±4)° at one month, six and 12 months after operation, and the knee active flexion range of motion gradually increased compared with that before operation. There were significant differences at each time point (F=314.984, P<0.05). The VAS score, WOMAC score and Lysholm score at one month, six and 12 months after operation were significantly improved compared with those before operation(F=1012.288, 822.45, 673.422, all P<0.05).

Conclusion

The distal tibial tubercle-high tibial osteotomy combined with arthroscopy can relieve the pain of moderate to severe varus knee osteoarthritis, improve the knee joint function, increase the range of motion of the knee joint, and has no significant effect on the medial and lateral posterior tibial slope angle in the short term.