| Objective:In this study,arthroscopy combined with tibial high osteotomy was used to treat varus knee osteoarthritis,to investigate the improvement of knee function,pain and quality of life in patients with varus knee osteoarthritis,and to evaluate its clinical efficacy.Methods:Retrospective analysis of 83 patients with knee osteoarthritis(varus type)admitted between 2017-09 and 2019-01 in minimally invasive arthrology department of the third affiliated hospital of beijing university of traditional chinese medicine,aged 50?81 years.According to the order of diagnosis and treatment and the mode of operation,they were divided into arthroscopy combined with high tibial osteotomy group(test group,41 cases)and simple arthroscopy group(control group,42 cases).All patients were followed up for more than 12 months.Two groups of patients before the operation of the knee negative position full-length X,non-negative position positive lateral axis X,knee MRI?CT and other examinations.Control group single pure arthroscopic exploration and cleaning,specific package Include:synovial cleaning,free body removal,synovial fold and pterygoid ligament resection,meniscus dressing,intercondylar fossa molding,etc.After arthroscopic cleaning,the experimental group continued to perform open wedge high tibial single plane osteotomy with distal tibial tubercle.Allogeneic bone was implanted with ? locking plate.The VAS scores before and after 3 months,end of June and end of December,knee joint score(HSS),Xi'an University of Western Ontario and McMaster University osteoarthritis index score(WOMAC)were compared.The differences of scores,HSS scores and WOMAC scores were compared between the two groups before and after operation and at the end of 12 months after operation.Using Excel table to collect and collate the data before and after treatment,using SPSS 22.0 software to analyze the data,using Origin 2019 software to map the final results.Results:1.Comparison between two groups of patients before treatmentBefore treatment,there were no statistically significant differences between the two groups in gender(?2=0.205,P=0.651>0.05),age t=-0.819,P=0.923>0.05),disease course(t=-0.782,P=0.196>0.05),and BMI(t=-0.926,P=0.172>0.05)Before treatment,VAS score(t=0.294,P=0.673>0.05),HSS score(t=-0.027,P=0.458>0.05),WOMAC score(t=-0.809,P=0.297>0.05),Femoral and Tibial Angle(t=1.550,P=0.073>0.05),and negative gravity line ratio of lower limbs(t=4.011,P=0.613>0.05)were not statistically significant and were comparable2.Intra-group comparison of knee joint evaluation at each time point between the two groupsComparison of VAS in the test group:VAS scores at the end of march,June and December after surgery were significantly lower than those before surgery,with statistically significant differences(F=323.003,P<0.001)Comparison within the HSS evaluation group of the experimental group:the HSS score at the end of march,the end of June and the end of December after the operation increased significantly compared with that before the operation,and the difference was statistically significant(F=275.460,P<0.001)Comparison within the WOMAC evaluation group of the experimental group:WOMAC scores at the end of march,the end of June and the end of December after the operation were significantly lower than those before the operation,with statistically significant differences(F=383.693,P<0.001)Comparison of VAS in the control group:VAS scores at the end of 3 months,6 months and 12 months after surgery were significantly lower than those before surgery,with statistically significant differences(F=119.767,P<0.001)Comparison within the HSS evaluation group of the control group:HSS scores at the end of 3 months,6 months and 12 months after surgery were significantly increased compared with those before surgery,with statistically significant differences(F=354.758,P<0.001)Comparison within WOMAC evaluation group of the control group:WOMAC scores at the end of 3 months,6 months and 12 months after the operation were significantly lower than those before the operation,and the difference was statistically significant(F=695.363,P<0.001).3.Comparison between groups of knee joint evaluation at each time point in the two groupsComparison of VAS scores between the two groups:compared with the control group,the difference between VAS scores and the control group at the end of 3 months(t=-0.162,P=0.543<0.05),at the end of 6 months(t=-7.689,P=0.019<0.05)and at the end of 12 months(t=-16.553,P=0.012<0.05)was larger than that of the control group.Comparison of HSS scores between the two groups:compared with the control group,the difference(increase)of HSS scores between the test group and the control group at each time point at the end of 3 months(t=0.954,P=0.210<0.05),the end of 6 months(t=4.947,P=0.034<0.05)and the end of 12 months(t=9.789,P=0.024<0.05)was larger than that of the control group,and the difference was statistically significant.Comparison of WOMAC evaluation between the two groups:compared with the control group,the difference(decrease)of WOMAC score between the experimental group and the control group at each time point at the end of 3 months(t=-1.124,P=0.105<0.05),the end of 6 months(t=-3.768,P=0.005<0.05)and the end of 12 months(t=-14.233,P=0.017<0.05)was larger than that of the control group,and the difference was statistically significant4.Comparison of the ratio of Femur and Tibial Angle and the negative gravity line of lower limbs in the experimental group before and after surgery at 6 months and 12 monthsComparison of the femoral tibial Angle in the test group:after surgery(t=-22.154,P=0.041<0.001),at the end of 12 months after surgery(t=-19.256,P=0.037<0.001),the femoral tibial Angle decreased compared with that before surgery,and the difference was statistically significant.Comparison of lower limb negative gravity line ratio in the test group:the lower limb negative gravity line ratio after surgery(t=80.875,P=0.016<0.001)and at the end of 12 months after surgery(t=96,533,P=0.046<0.001)increased compared with that before surgery,and the difference was statistically significantConclusion:1.The early efficacy of arthroscopy alone and arthroscopy combined with tibial high osteotomy in the treatment of varus KOA was similar,both of which could significantly improve symptoms.2.After half a year,the overall efficacy of arthroscopy combined with tibial high osteotomy group was better than that of the single arthroscopy group,and the efficacy lasted longer.3.Arthroscopic surgery can restore the intra-articular environment as soon as possible,and the short-term improvement of symptoms is obvious;Tibial high osteotomy can correct varus deformity,restore the normal line of force of the lower limb,reduce or eliminate the state of high pressure in the medial gap,can maintain a satisfactory effect for a long time. |
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