切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 633 -641. doi: 10.3877/cma.j.issn.1674-134X.2023.05.006

临床论著

胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效
张中斌, 付琨朋†(), 朱凯, 张玉, 李华   
  1. 050000　石家庄，河北省第八人民医院
  • 收稿日期:2022-11-03 出版日期:2023-10-01
  • 通信作者: 付琨朋
  • 基金资助:
    河北省医学科研课题(2019061451)

High tibial osteotomy and platelet rich plasma in treatment of knee osteoarthritis

Zhongbin Zhang, Kunpeng Fu†(), Kai Zhu, Yu Zhang, Hua Li   

  1. The Eighth People's Hospital of Hebei Province, Shijiazhuang 050000, China
  • Received:2022-11-03 Published:2023-10-01
  • Corresponding author: Kunpeng Fu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.

Zhongbin Zhang, Kunpeng Fu, Kai Zhu, Yu Zhang, Hua Li. High tibial osteotomy and platelet rich plasma in treatment of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 633-641.

目的

探讨富血小板血浆配合胫骨高位截骨术治疗膝骨关节炎的疗效观察。

方法

选取2017年4月至2020年10月河北省第八人民医院膝骨关节炎患者61例作为研究对象。纳入标准：符合中膝骨关节炎相关诊断标准；骨关节炎Kellgren-Lawrence (K-L)分级Ⅱ~Ⅳ级；膝关节半月板功能、外侧软骨正常等。排除标准：膝关节不稳；膝关节多间室软骨磨损；合并膝关节内游离体；化脓性、类风湿性及痛风性关节炎者；心脑血管疾病或肝肾功能严重障碍；严重骨质疏松症。按照随机数字表法分为两组，联合组31例，行胫骨高位截骨术联合富血小板血浆治疗；单纯截骨组30例，行胫骨高位截骨术。组间比较两组围手术期指标及术后并发症发生率。重复测量方差分析两组术前、术后1个月、6个月膝关节美国特种外科医院(HSS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、疼痛视觉模拟评分(VAS)、股胫角(FTA)、胫骨后倾角(PTS)、胫骨近端内侧角(MPTA)、膝关节内翻角(KVA)及术前、术后1个月纤维蛋白原(FIB)、D-二聚体(D-D)、血栓素(TXA2)水平及膝关节液中miR-140、miR-155表达。

结果

联合组手术时间、术中出血量、术后引流量及首次下床时间与单纯截骨组比较，差异无统计学意义(t＝1.095、0.900、0.313、0.698，均为P>0.05)；术后6个月，联合组HSS评分、WOMAC评分高于单纯截骨组，VAS评分低于单纯截骨组，差异有统计学意义(F＝6.426、6.514、6.552，均为P<0.05)；与术前相比，两组术后1个月、6个月FTA、PTS均明显下降，MPTA、KVA均显著升高，差异有统计学意义(F＝5.528、5.556、5.506、5.223，均为P<0.05)；两组术前、术后1个月FIB、D-D、TXA2比较，差异无统计学意义(均为P>0.05)；术后6个月联合组膝关节液中miR-155低于单纯截骨组，miR-140表达高于单纯截骨组，差异有统计学意义(t＝2.198、4.622 ，均为P<0.05)；两组的并发症发生率差异无统计学意义(χ2＝0.601，P>0.05)。

结论

胫骨高位截骨术联合富血小板血浆治疗膝骨关节炎，可显著调节膝关节液中miR-140、miR-155表达，明显改善患者膝关节功能，减轻疼痛，值得临床推广与应用。

关键词: 胫骨高位截骨术, 富血小板血浆, 骨关节炎，膝, 凝血因子, 微小RNAs
Objective

To investigate the effect of platelet rich plasma combined with high tibial osteotomy in the treatment of knee osteoarthritis.

Methods

Sixty-one patients with knee osteoarthritis admitted to Hebei Eighth People's Hospital from April 2017 to October 2020 were selected as research subjects, which all met the relevant diagnostic criteria of knee osteoarthritis; grade Ⅱ~Ⅳof Kellgren-Lawrence grading scale (K-L) for osteoarthritis; normal meniscus function and lateral cartilage of the knee joint, etc.. Exclusion criteria: instable knee joint, multiple compartment cartilage lesions, loose body in knee joint, other arthritis diseases, severe cerebral-cardiovascular diseases or hepatic-renal insufficiency, severe osteoporosis. The patients were divided into two groups according to the random number table method: 31 cases in the combined group were treated by high tibial osteotomy combined with platelet-rich plasma, while the other 30 cases in the osteotomy group were treated by high tibial osteotomy. Perioperative indicators and postoperative complication rates between the two groups were compared. Repeated measurement analysis of variance was used to analyze the American Hospital for Special Surgery (HSS) scores, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, visual analogue scale (VAS), the femoral tibial angle (FTA), the posterior tibial slope (PTS), the proximal medial tibial angle (MPTA), and the knee varus angle (KVA) of the two groups before operation, at one month and six months after operation; fibrinogen (FIB), D-dimer (D-D), thromboxane (TXA2) and the expression of miR-140 and miR-155 in knee joint fluid before and one month after operation were also analyzed.

Results

There was no statistically significant difference in the operating time, intraoperative blood loss, postoperative drainage and the ambulant time between the two groups (t=1.095, 0.900, 0.313, 0.698, all P>0.05). Six months after surgery, the HSS score and WOMAC score in the combined group were higher than those in the osteotomy group, and the VAS score was lower than those in the osteotomy group, and the differences were statistically significant (F=6.426, 6.514, 6.552, all P<0.05). Compared with preoperative data, both groups showed a significant decrease in FTA and PTS at one and six months after surgery, while MPTA and KVA increased significantly (F=5.528, 5.556, 5.506, 5.223, all P<0.05). There was no statistically significant difference in FIB, D-D, and TXA2 between the two groups before and one month after surgery (all P>0.05). At six months after surgery, the miR-155 in the knee joint fluid of the combined group was lower than that of the osteotomy group, and the expression of miR-140 was higher than that of the osteotomy group, with statistically significant differences (t=2.198, 4.622, both P<0.05). The difference in complication incidence between the two groups was not statistically significant (χ2=0.601, P>0.05).

Conclusion

High tibial osteotomy combined with platelet-rich plasma in the treatment of knee osteoarthritis can improve the coagulation function of patients, regulate the expression of miR-140 and miR-155 in knee joint fluid, improve knee joint function and relieve pain, and is worthy of clinical promotion and application.

Key words: Tibia, Osteotomy, Platelet-rich plasma, Osteoarthritis, knee, Blood coagulation factors, MicroRNAs
表1 两组临床资料比较
Table 1 Comparison of clinical data between two groups
组别Groups 例数Number of cases 性别(男/女)Gender(male/female) 年龄[岁，(±s)]Age (years) 身体质量指数[kg/m2，(±s)]Body mass index K-L分级[例(%)]K-L classification
Ⅱ级 Ⅲ级 Ⅳ级
联合组Combined group 31 12/19 52.6±3.1 24.5±2.2 14(45.2) 15(48.4) 2(6.5)
单纯截骨组Osteotomy group 30 10/20 51.8±3.1 24.2±2.1 13(43.3) 14(46.7) 3(10.0)
统计值   χ2＝0.191 t＝0.932 t＝0.524 χ2＝0.255
P值   >0.05 >0.05 >0.05 >0.05
表2 两组围手术期指标比较(±s)
Table 2 Comparison of perioperative indicators between two groups
组别Groups 例数Number of cases 手术时间(min)Operation time 术中出血量(ml)Intraoperative blood loss 术后引流量(ml)Postoperative drainage 术后首次下床时间(d)Postoperative ambulant time
联合组Combined group 31 62.4±8.3 68.7±13.6 74.1±9.8 1.9±0.6
单纯截骨组Osteotomy group 30 59.7±10.8 65.4±15.3 75.1±12.7 2.1±0.6
t值   1.095 0.900 0.313 0.698
P值   >0.05 >0.05 >0.05 >0.05
表3 两组膝关节临床指标比较[分，(±s)]
Table 3 Comparison of clinical indicators of two groups of knee joints [score，(±s)]
组别Groups 例数Number of cases HSS评分HSS score
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 58.3±4.3 73.1±5.3a 85.3±4.3a
单纯截骨组Osteotomy group 30 57.3±5.3 72.0±6.0a 79.1±5.4a
F值   组间：8.032，时间：5.124，交互：6.426
P值   组间：<0.001，时间：0.039，交互：0.015
组别Groups 例数Number of cases WOMAC评分WOMAC score
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 55.3±4.2 71.2±5.7a 83.9±3.3a
单纯截骨组Osteotomy group 30 54.2±5.1 69.8±6.0a 76.9±3.3a
F值   组间：7.998，时间：5.029，交互：6.514
P值   组间：<0.001，时间：0.035，交互：0.014
组别Groups 例数Number of cases VAS评分VAS score
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 6.6±2.4 2.9±0.8a 1.3±0.5a
单纯截骨组Osteotomy group 30 6.7±2.4 3.3±0.7a 2.1±0.6a
F值   组间：7.952，时间：5.037,交互：6.552
P值   组间：<0.001，时间：0.036,交互：0.017
表4 两组膝关节角度比较[°，(±s)]
Table 4 Comparison of knee joint angles between two groups
组别Groups 例数Number of cases FTA
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 186.9±3.8 179.8±2.4a 171.7±1.8a
单纯截骨组Osteotomy group 30 186.4±4.1 180.3±2.6a 172.1±2.0a
F值   组间：2.528，时间：7.285，交互：5.528
P值   组间：>0.05，时间：0.014，交互：0.037
组别Groups 例数Number of cases MPTA
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 83.3±3.2 88.8±3.4a 94.3±3.2a
单纯截骨组Osteotomy group 30 82.9±2.9 89.3±3.7a 93.8±3.6a
F值   组间：2.314，时间：7.037，交互：5.556
P值   组间：>0.05，时间：0.016，交互：0.041
组别Groups 例数Number of cases PTS
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 8.3±0.7 8.8±0.7a 9.3±0.7a
单纯截骨组Osteotomy group 30 8.6±0.7 9.1±0.7a 9.6±0.7a
F值   组间：1.285，时间：6.895,交互：5.506
P值   组间：>0.05，时间：0.026,交互：0.040
组别Groups 例数Number of cases KVA
术前Before operation 术后1个月One month after operation 术后6个月Six months after operation
联合组Combined group 31 12.8±3.3 5.2±1.3a 1.5±0.6a
单纯截骨组Osteotomy group 30 12.3±2.9 5.1±1.4a 1.4±0.8a
F值   组间：1.952，时间：6.415,交互：5.223
P值   组间：>0.05，时间：0.0268,交互：0.042
表5 两组凝血相关指标比较(±s)
Table 5 Comparison of coagulation related indicators between two groups
组别Groups 例数Number of cases FIB(g/L) D-D(mg/L) TXA2(μg/L)
术前Before surgery 术后1个月One month after surgery 术前Before surgery 术后1个月1 One month after surgery 术前Before surgery 术后1个月One month after surgery
联合组Combined group 31 3.67±0.52 2.54±0.41a 0.97±0.34 0.52±0.25a 412.94±85.29 207.46±65.27a
单纯截骨组Osteotomy group 30 3.84±0.59 3.02±0.47a 0.92±0.36 0.67±0.31a 415.27±80.16 267.41±70.52a
t值   1.195 4.255 0.558 2.084 0.110 3.447
P值   >0.05 <0.001 >0.05 0.042 >0.05 0.001
表6 两组膝关节液中miR-140、miR-155表达比较(±s)
Table 6 Comparison of miR-140 and miR-155 expression in knee joint fluid between two groups
组别Groups 例数Number of cases miR-140 miR-155
术前Before surgery 术后1个月One month after surgery 术前Before surgery 术后1个月One month after surgery
联合组Combined group 31 0.98±0.41 2.01±0.82a 2.88±0.74 0.75±0.24a
单纯截骨组Osteotomy group 30 1.02±0.45 1.57±0.74a 2.74±0.69 1.04±0.25a
t值   0.363 2.198 0.764 4.622
P值   >0.05 0.032 >0.05 <0.001
表7 两组术后并发症发生率比较[例(%)]
Table 7 Comparison of postoperative complication indence between two groups
组别Groups 例数Number of cases 关节粘连Joint adhesion 切口感染Incision infection 膝关节僵硬Knee stiffness 下肢DVT Lower limb DVT 总发生率Total incidence
联合组Combined group 31 1(3.2) 1(3.2) 1(3.2) 0 3(9.7)
单纯截骨组Osteotomy group 30 2(6.7) 1(3.3) 2(6.7) 1(3.3) 6(20.0)
χ2值           0.601
P值           >0.05
图1 术前左膝关节X线图像。图A为左膝关节正位X线片，可见患者内侧股胫间室间隙明显变窄，表面软骨磨损严重；外侧股胫间室间隙良好，表面软骨轻度退变；图B为左膝关节侧位片，示髌股关节无明显骨质增生及软骨退变；图C为双下肢负重全长X线片，示MPTA≤82°，胫骨内翻畸形
Figure 1 Preoperative X-ray images. A is X-ray of anterior-posterior view of left knee joint, showing that the medial femoral tibial compartment space of the patient has significantly narrowed, and the surface cartilage is severely worn; The lateral femoral tibial compartment space is good, with mild degeneration of the surface cartilage. B is the lateral view of left knee joint, showing no obvious hyperostosis and cartilage degeneration in the patellofemoral joint; C is full length X-ray film of double lower limb at weight-bearing postion，showing MPTA ≤ 82° and the presence of varus deformity in the tibia
图2 术后膝关节X线图像。图A为双下肢负重全长X线片，示术后左下肢力线与术前比较得到了纠正(自股骨头中心至踝关节中心作一直线，髌骨中点位于此直线上，达到了目标力线的效果)；图B为左膝关节正位片，示内侧间室关节间隙增大；图C为左膝关节侧位片，示PTA(胫骨平台后倾角)保持在正常值7°左右
Figure 2 Postoperative X-ray images of knees. A is full length X-ray film of bilateral lower limbs at weight-bearing position, showing that the left lower limb force line has been well corrected after surgery ( a straight line is drew from the center of the femoral head to the center of the ankle joint, with the midpoint of the patella located on this line, the effect of the target force line was achieved; B is X-ray of anterior-posterior view of left knee joint, showing that the medial interventricular joint space was enlarged after surgery; C is lateral view of left knee joint，showing that PTA remains at a normal value of about seven degrees after operation
[1]
Vincent KR, Vasilopoulos T, Montero C, et al. Eccentric and concentric resistance exercise comparison for knee osteoarthritis[J]. Med Sci Sports Exerc, 2019, 51(10): 1977－1986.
[2]
付阳阳，龚利，姜淑云，等. 坐位调膝法治疗膝骨关节炎即刻疗效的相关因素分析[J]. 中医药导报，2020, 26(8): 32－34, 44.
[3]
Alkhawajah HA, Alshami AM. The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial[J/OL]. BMC Musculoskelet Disord, 2019, 20(1): 452. DOI: 10.1186/s12891-019-2841-4.
[4]
周鑫，刘祺，梁涛，等. 关节镜结合胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效分析及对软骨损伤的影响[J]. 中国修复重建外科杂志，2021, 35(6): 690－696.
[5]
Li S, Yang J, Watson C, et al. Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study[J]. Int Orthop, 2020, 44(6): 1037－1043.
[6]
Cai YU, Sun Z, Liao B, et al. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears[J]. Med Sci Sports Exerc, 2019, 51(2): 227－233.
[7]
栾烁，栗晓，林彩娜，等. 超声引导下关节腔注射富血小板血浆治疗膝骨性关节炎疗效的回顾性研究[J]. 华西医学，2020, 35(5): 568－573.
[8]
赵轶男，孙强，毕龙，等. miR-130a-3p调控SOX4对骨关节炎软骨细胞增殖、分化和炎症因子释放的影响[J]. 现代生物医学进展，2019, 19(22): 4201－4207.
[9]
樊萍，冯秀媛，胡楠，等. miR-138靶向GRK6调控骨关节炎软骨细胞增殖和凋亡的研究[J]. 河北医药，2021, 43(1): 10－15.
[10]
中华医学会骨科学分会. 骨关节炎诊治指南(2007年版)[J]. 中华骨科杂志，2007, 27(10): 287－288.
[11]
刘泽，韩广普，刘国强. 三维步态分析仪量化评价UKA与TKA治疗内侧单间室KOA疗效及生活质量的影响[J]. 河北医药，2020, 42(10): 1470－1474.
[12]
Wang Z, Jones G, Winzenberg T, et al. Effectiveness of Curcuma longa extract for the treatment of symptoms and effusion-synovitis of knee osteoarthritis: a randomized trial[J]. Ann Intern Med, 2020, 173(11): 861－869.
[13]
李慧，曾明珠，张瑜. 补肾强筋胶囊对早中期膝骨性关节炎滑液中白细胞介素-1β、肿瘤坏死因子-α、前列腺素E2及血清前列腺素E2的影响[J]. 中国医药导报，2019, 16(15): 119－123.
[14]
Yuenyongviwat V, Duangmanee S, Iamthanaporn K, et al. Effect of hip abductor strengthening exercises in knee osteoarthritis: a randomized controlled trial[J/OL]. BMC Musculoskelet Disord, 2020, 21(1): 284. DOI: 10.1186/s12891-020-03316-z.
[15]
Chiari C, Grgurevic L, Bordukalo-Niksic T, et al. Recombinant human BMP6 applied within autologous blood coagulum accelerates bone healing: randomized controlled trial in high tibial osteotomy patients[J]. J Bone Miner Res, 2020, 35(10): 1893－1903.
[16]
刘日，谢坤南，杨山辉，等. 关节镜下清理联合胫骨高位截骨术治疗膝关节骨性关节炎的疗效分析[J]. 中国骨与关节损伤杂志，2020, 35(2): 185－187.
[17]
Sirithanabadeekul P, Dannarongchai A, Suwanchinda A. Platelet-rich plasma treatment for melasma: a pilot study[J]. J Cosmet Dermatol, 2020, 19(6): 1321－1327.
[18]
孙仁义，贾堂宏. 关节腔内注射透明质酸钠与富血小板血浆治疗膝关节骨性关节炎的比较[J]. 中国组织工程研究，2020, 24(14): 2164－2169.
[19]
丁文聪，陈陶甫，缪辉宇. 木防己汤联合甲氨蝶呤对类风湿关节炎急性发作期患者氧自由代谢、骨代谢及凝血状态的影响[J]. 中国医药导报，2020, 17(18): 131－134, 142.
[20]
di Martino A, di Matteo B, Papio T, et al. Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial[J]. Am J Sports Med, 2019, 47(2): 347－354.
[21]
周明，赵晨钰，高谦，等. 自体去白细胞富血小板血浆治疗膝骨关节炎的早期临床疗效观察[J]. 解放军医学院学报，2019, 40(8): 757－759, 763.
[22]
斯海波，梁明玮，程惊秋，等. 软骨前体细胞及微小RNA-140在骨关节炎软骨损伤修复中的作用[J]. 中国修复重建外科杂志，2019, 33(5): 650－656.
[23]
张健，焦永伟，王响，等. 老年膝骨性关节炎患者外周血miR-155和NLRP3表达的关系[J]. 中国老年学杂志，2021, 41(17): 3694－3697.
[24]
Shapiro J, Ho A, Sukhdeo K, et al. Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: a randomized controlled trial[J]. J Am Acad Dermatol, 2020, 83(5): 1298－1303.
[25]
黄凯华，吴志浩，张子亮，等. 透明质酸、富血小板血浆及两者联合应用对膝骨关节炎的疗效评估[J]. 中国骨质疏松杂志，2019, 25(12): 1707－1711.
[1] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[2] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[3] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[4] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[5] 欧阳剑锋, 李炳权, 叶永恒, 胡少宇, 向阳. 关节镜联合富血小板血浆治疗粘连性肩周炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 765-772.
[6] 刘伦, 王云鹭, 李锡勇, 韩鹏飞, 张鹏, 李晓东. 机器人辅助膝关节单髁置换术的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 715-721.
[7] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[8] 王泽勇, 覃健. 白细胞含量对富血小板血浆治疗运动系统损伤的影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 684-688.
[9] 周晓强, 金宇杰, 李志强, 徐人杰, 张向鑫, 陈广祥, 虞宵. 运动学与机械学对线在全膝关节置换中的比较研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(04): 554-559.
[10] 詹钦文, 靳科, 袁家钦. 不同浓度自体富血小板血浆对慢性跟腱损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(04): 500-507.
[11] 胡银华, 薛龙. 中国中老年人症状性膝骨关节炎的发病率及危险因素[J]. 中华关节外科杂志(电子版), 2023, 17(04): 470-478.
[12] 韩李念, 王君. 放射性皮肤损伤治疗的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 533-537.
[13] 马聪, 李雪靖, 郑晓佐, 张晓阳, 段坤峰, 刘国强, 郄素会. 关节腔内注射富血小板血浆与透明质酸钠治疗Ⅰ-Ⅲ期膝骨关节炎的对比研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 282-288.
[14] 宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮. 开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 226-232.
[15] 张镇斌, 闫兆龙, 王功腾, 张文琦, 王旭凤, 李广兴, 孙华强, 李树锋. 关节镜对胫骨高位截骨术治疗膝骨关节炎的效果研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 218-225.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号