Clinical Study Of Knee Arthroscopy Combined With Proximal Fibula Osteotomy For Osteoarthritis Of The Knee

Objective: The high incidence of osteoarthritis of the knee(KOA),has seriously affected people’s lives.Because its pathogenesis is not completely clear,a simple and effective treatment option has not been found.With the discovery of the uneven settlement theory,we have a new awareness about the osteoarthritis of the knee.This research aims at the comparative analysis about Knee Arthroscopy combined with Proximal tibia and fibula osteotomy which bears the judgement about the clinical effectiveness of fibular osteotomy and the important status of Arthroscopy in the treatment of osteoarthritis of the knee.A wide range of indications,minor surgical trauma and universal access to the treatment of osteoarthritis of the knee surgery can be used in clinical practice.Methods: From December 2014 to March 2017,patients with knee osteoarthritis combined with knee varus were admitted to the outpatient department of the hospital.The age is between 45 and 70 years old.After informed consent,a random number table was used to obtain 60 random numbers and recorded.Each enrolled case received a random number in turn,and the remainder was divided by the patient’s hospitalization number by the random number.Even number was included in the control group,and finally 51 patients were included in the group,including the experimental group(group A,a total of 26 cases)and the control group(group B,a total of 25 cases).The experimental group used arthroscopy combined with fibula osteotomy;the control group only received fibula osteotomy.Both groups of patients were operated by the same group of professionally trained surgeons and assistants.Arthroscopic cleaning standard: the conventional patellar ligament lateral approach was used to observe in the order of patella trochlear,suprapatellar capsule,medial femoral condyle,medial tibiofemoral joint,intercondylar fossa,lateral femoral condyle,and lateral tibiofemoral joint.According to the severity of the disease,remove the synovial tissue,remove the exfoliated cartilage,trim and/or remove the meniscus,plan the joint surface,and remove the osteophyte until the joint surface is smooth and flat.Then use a large amount of sterile saline until the rinse solution is clear and free of tissue debris.The incision was sutured,and the sterile dressing was applied under pressure.Fibular osteotomy: Make an incision of about 2～3cm in the upper 1/3 of the fibula of the affected side,cut the skin subcutaneously,and enter the gap between the long and short fibula and soleus muscles,peel off the periosteum,expose the fibula,protect the surrounding For soft tissues,use electric pendulum saw and rongeur to cut about 2.0cm fibula,carefully separate the surrounding soft tissues to avoid nerve damage.Bone wax should be used to seal the medullary cavity to stop bleeding and prevent bone regeneration and healing.Suture the skin.Experimental group: Fibular osteotomy was performed after arthroscopic cleaning;Control group: Fibula osteotomy only.Postoperative treatment was the same in both groups.After knee compress for 48 hours,the muscle strength of the quadriceps and hamstrings was exercised early.The patient underwent full weight bearing statically the next day after surgery and was discharged within 3 days of hospitalization.Before operation,the two groups of patients were examined with X-rays of the knee under weight-bearing position,filled in the Lysholm score form,and applied F-Scan system to collect static and dynamic plantar pressure data of the patients.X-rays were taken 3 days and 1 year after surgery.F-Scan system was used to collect static and dynamic plantar pressure data of patients one year after surgery.1 month,3 months,and 12 months after operation,the patient came to the hospital for review and telephone follow-up,and filled out the Lysholm score form.All the data obtained were statistically processed using SPSS 20.0 software,and the data values were expressed as mean ± standard deviation.The operations within the same group were compared with each other before and after the operation using repeated measurement analysis of variance,and the pairwise comparison was made using SNK Test;comparison between two groups using independent sample t test;test level α=0.05,P<0.05.Result:1.The categorical variables in the general information of the two groups of patients were compared by chi-square test,and the continuous variables were compared by the paired sample t test.The data analysis results showed that the differences were not statistically significant(P>0.05)and were comparable.2.The analysis of plantar pressure after 1 year shows that the static pressure of the plantar of the knee osteoarthritis of the two groups of patients is distributed on the lateral side of the foot,and the pressure of the lateral foot of the patient is reduced after the operation.The static plantar pressure shifted inwards,reflecting the improvement of the lower limb force lines after treatment;while the dynamic plantar pressure analysis of the two groups showed no difference before and after surgery.There was no difference between the two groups.3.The Lysholm score of the experimental group was better than the control group at 1 month after surgery,the difference was statistically significant(P <0.05);There was no difference in Lysholm score between the two groups at 3 and 12 months after surgery Statistical significance(P>0.05).Conclusion:1.Knee varus osteoarthritis with simple fibula osteotomy is effective in treating knee osteoarthritis.And the long-term effect of combined arthroscopic surgery is equivalent.2.Arthroscopic treatment of knee osteoarthritis can effectively relieve the symptoms of knee pain in the early stage of treatment.3.Static plantar pressure analysis can evaluate the improvement of knee osteoarthritis in an objective and quantitative way.4.Dynamic plantar pressure analysis failed to reflect the improvement of knee osteoarthritis.