回顾性分析关节镜联合胫骨内侧高位双平面截骨术治疗内侧间室膝关节骨关节炎的临床疗效。

选取北京大学首钢医院骨科2018年8月至2022年1月，关节镜探查联合胫骨内侧高位截骨术治疗内侧间室膝关节骨关节炎并成功随访28例患者（29膝），其中，男性3例（3膝），女性25例（26膝）；年龄45~71岁，平均（57.8±6.2）岁。采用疼痛视觉模拟评分（VAS）、HSS膝关节评分、膝关节Lysholm评分系统、膝关节活动度（ROM）对术后疗效进行评价，在术前、术后标准正侧位X线片中测量：胫股角（FTA）、胫骨近端内侧角（MPTA），记录术后3月膝关节活动度。记录并发症的发生情况。所得结果采用配对t检验进行统计学分析，以P＜0.01为差异有统计学意义。

患者随访8~48个月，平均（25.8±12.8）个月。关节镜下观察到29侧膝关节合并其他损伤，包括半月板撕裂（29膝）、关节软骨损伤（29膝）、髁间窝狭窄（9膝）、软骨游离体（6膝）等。术后患者的膝内翻畸形均得到有效纠正。VAS评分：术前（6.28±0.649）分，术后3个月（1.52±0.509）分；HSS评分：术前（62.34±4.125）分，术后3个月（89.48±2.544）分；Lysholm评分：术前（57.17±3.855）分，术后3个月（79.93±4.200）分；FTA：术前（183.87±1.604）°，术后3个月（174.85±0.834）°；胫骨近端内侧角（MPTA）：术前（83.39±0.997）°，术后3个月（89.99±1.372）°；膝关节活动度：术前（105±7.559）°，术后3个月（126.90±4.100）°；手术前后VAS评分、HSS评分、Lysholm评分、FTA、MPTA、关节活动度差异有统计学意义（P＜0.01）。随访期间1例出现术后3月切口感染，清创加VSD治疗后伤口愈合，未观察到内固定失效的病例，未发现截骨处不愈合的情况。

关节镜探查联合胫骨内侧高位截骨术能够有效矫正患肢力线，缓解疼痛症状，并且能及时发现关节内合并其他结构损伤的情况，同时采用措施进行干预，是治疗内侧间室膝关节骨关节炎的一种安全有效的方法。

To retrospectively analyze the clinical efficacy of arthroscopy combined with medial high biplanar tibial osteotomy in the treatment of medial compartment knee osteoarthritis.

From August 2018 to January 2022, 28 patients (29 knees) with medial compartment knee osteoarthritis were successfully followed up under the concept of enhanced recovery after arthroscopic exploration combined with high medial tibial osteotomy at Shougang Hospital, Peking University, including 3 males (3 knees) and 25 females (26 knees). Their average age was (57.8±6.2) years (range, 45~71 years). The visual analogue scale (VAS), HSS knee score, Lysholm score, and knee range of motion (ROM) were used to evaluate the postoperative efficacy. Preoperative and postoperative standard anteroposterial-lateral radiographs were used to measure tibiofemoral angle (FTA) and medial proximal tibia angle (MPTA) to record the range of motion of the knee at 3 months after operation. The occurrence of complications was recorded. Paired t test was used for statistical analysis, and P＜0.01 was considered statistically significant.

The patients were followed up for 8~48 months, with an average of (25.8±12.8) months. Arthroscopic examination revealed 29 knees combined with other injuries, including meniscus tear (29 knees), articular cartilage injury (29 knees), stenosis of intercondylar fossa (9 knees), cartilage free body (6 knees), etc. The varus deformity was effectively corrected after operation. VAS score [(6.28±0.649) vs (1.52±0.509)], HSS score [(62.34±4.125) vs (89.48±2.544)], Lysholm score [(57.17±3.855) vs (79.93±4.200)], FTA [(183.87±1.604)° vs (174.85±0.834)°], MPTA [(83.39±0.997)° vs (89.99±1.372)°], and the range of motion of the knee joint [(105±7.559)° vs (126.90±4.100)° were significantly improved 3 months after operation compared with those before operation (P＜0.01). During the follow-up period, 1 case had wound infection 3 months after operation, and the wound healed after debridement and VSD treatment. No failure of internal fixation was observed, and no nonunion of osteotomy site was found.

Arthroscopic exploration combined with high tibial osteotomy can effectively correct the force line of the affected limb, relieve pain symptoms, and timely detect other structural injuries in the joint, as well as take intervention measures simultaneously representing a safe and effective method for the treatment of medial compartment knee osteoarthritis.