比较胫骨内侧撑开楔形高位双平面截骨术(OWHTO)与Oxford Ⅲ代单髁置换治疗膝关节内侧间室骨关节炎的早期疗效及治疗费用。

回顾性分析2014年1月至2018年1月内蒙古自治区人民医院收治的内侧胫股关节炎患者共48例(48膝)，除外感染性关节炎及外侧骨关节炎患者，按照手术方式不同分为胫骨内侧撑开楔形高位双平面截骨术组(截骨组)和单髁置换组(单髁组)。A组12例(12膝)，男4例，女8例，年龄平均(58.3±3.5)岁；B组36例(36膝)，男14例，女22例，平均年龄(59.4±4.5)岁。分别于术前、术后6个月对两组患者进行疼痛模拟评分(VAS)、美国特种外科医院(HSS)膝关节评分，并拍摄膝关节正侧位X线片，测量膝内翻角度。使用两独立样本t检验及卡方检验比较两组患者手术前后VAS、HSS评分，以及患者住院和术后康复费用。

所有患者均获得满意随访，随访时间平均(8.5±1.8)个月。截骨组患者VAS评分术前(7.62±0.51)分，术后(2.15±0.26)分，术后与术前相比，差异有统计学意义(t＝1.61，P<0.05)；单髁组VAS评分术前(7.73±0.64)分，术后(2.31±0.14)分，术后与术前相比，差异有统计学意义(t＝2.09，P<0.05)。截骨组患者HSS评分术前(56± 5)分，术后(88±3)分，评分改善(t＝24.11，P<0.05)；单髁组HSS评分术前(57±6)分，术后(91±4)分，评分改善(t＝26.75，P<0.05)。两组患者VAS、HSS评分无明显差异，而截骨组住院费用显著低于单髁组(t＝3.59，P<0.05)。

两组患者均获得良好的早期疗效，但胫骨内侧撑开楔形高位双平面截骨术住院费用及术后康复治疗费用更少，同时又达到了"保膝"的目的，所以，对于两种术式均合适的患者，可以优先考虑胫骨内侧撑开楔形高位双平面截骨术。

To compare the early effects and costs between open wedge high tibial osteotomy(OWHTO)and unicompartmental knee arthroplasty(UKA) for medial compartmental knee osteoarthritis.

A total of 48 patients (48 knees) with medial tibiofemoral arthritis from January 2014 to January 2018 were retrospectively analyzed. The patients with inflammatory knee arthritis and lateral knee osteoarthritis were excluded. According to the different surgical methods, they were divided into the OWHTO group (12 patients received OWHTO, four males and eight females) with an average age of (58.3±3.5)years, and the UKA group (36 patients received UKA, 14 males and 22 females) with an average age of (59.4±4.5)years. Visual analogue score (VAS), hospital for special surgery knee score (HSS) of the two groups were performed before and six months after surgery. X-ray of the antero-posterior and lateral positions to measure the varus angle of the knee, as well as the cost of hospitalization and postoperative rehabilitation. Two independent samples t test and chi-square test were used for statistical analysis.

All the cases were followed up satisfactorily. The follow-up time was(8.5±1.8)months on average. The VAS score of patients in the OWHTO group was (7.62±0.51) points before operation and (2.15±0.26) points after operation. There was a significant difference between the postoperative and preoperative values (t =1.61, P<0.05); the VAS score of UKA group was the points before operation (7.73±0.64) and after operation (2.31±0.14) were statistically significant (t =2.09, P <0.05). The HSS score of patients in the OWHTO group was (56±5) points before operation and (88±3) points after operation. There was a statistically significant difference (t=24.11, P<0.05) in the UKA group. There were (57±6) points before operation and (91±4) points after operation. There was a statistically significant difference between the post-operation and pre-operation (t =26.75, P<0.05). No statistically significant difference was found in VAS and HSS scores between the two groups, while the hospitalization cost of the OWHTO group was remarkably less than that of the UKA group(t=3.59, P<0.05).

Both two methods can achieve good early results, while the cost of hospitalization and postoperative rehabilitation of the OWHTO is less, and may achieve the goal of "knee-preservation" . OWHTO may be a better choice for patients who are suitable for both procedures.