腓骨近端截骨对胫骨近端骨密度影响CT值测量研究

季卫平 沈继全 何世杰 陈金堂 李婕 王波 范秋平

[摘要] 目的 探討膝关节前内侧骨关节炎患者行腓骨近端截骨对胫骨近端骨密度的变化情况。 方法 将2015年1月至2018年8月在丽水市人民医院行腓骨近端截骨治疗的54例膝关节前内侧骨关节炎患者纳入本研究，观察术前、术后2年膝关节评分、视觉模拟评分、膝关节活动度、髋-膝-踝角和胫骨近端各部位CT值差异。 结果 （1）与术前相比，术后2年膝关节评分、视觉模拟评分、膝关节活动度、髋-膝-踝角均得到不同程度的改善;（2）术前及术后2年膝关节胫骨近端CT值内侧>外侧>髁间，胫骨近端上层>下层（P<0.05）（除上下层髁间比较）;（3）与术前相比，术后2年胫骨近端上层CT值内侧下降，外侧增加，然而近端下层内侧、外侧无明显变化。 结论 通过对膝关节内侧骨关节炎患者腓骨截骨术前、术后胫骨近端不同层面、不同部位的CT值变化，了解胫骨近端骨密度变化，同时进一步佐证“膝关节不均匀沉降”理论的合理性。

[关键词] 骨关节炎;不均匀沉降;CT值;胫骨平台;腓骨近端截骨术

[中图分类号] R687.3          [文献标识码] A          [文章编号] 1673-9701（2021）09-0014-05

Research on the measurement of CT value in the impacts of proximal fibular osteotomy on bone mineral density of proximal tibia

JI Weiping1   SHEN Jiquan1   HE Shijie1   CHEN Jintang1   LI Jie1   WANG Bo1   FAN Qiuping2

1.Department of Orthopedics， Lishui City People′s Hospital in Zhejiang Province， Lishui   323000， China; 2.Institute of Orthopedic Research， the First Affiliated Clinical Medical College of Lishui University， Lishui 323000， China

[Abstract] Objective To investigate the changes of bone mineral density of proximal tibia after proximal fibular osteotomy in patients with anterior medial knee osteoarthritis. Methods A total of 54 patients with anterior medial knee osteoarthritis undergoing proximal fibular osteotomy in Lishui City People's Hospital from January 2015 to August 2018 were included in this research. The knee score， visual analogue score， knee range of motion， hip-knee-ankle angle and CT value difference of proximal tibia were observed before and two years after operation. Results （1）Compared with pre-operation， the knee score， visual analogue score， knee range of motion and hip-knee-ankle angle were improved in different degrees 2 years after operation. （2）Before and two years after operation， the CT value of proximal tibia of knee joint was medial>lateral>intercondylar， and proximal tibia was superior >inferior（P<0.05）（except the intercondylar comparison）. （3）Compared with preoperative， the CT value of proximal superior tibia decreased on the medial side and increased on the lateral side 2 years after operation， but there was no obvious change on the medial side and lateral side of proximal inferior tibia. Conclusion Through the changes of CT values in different layers and different parts of proximal tibia before and after fibular osteotomy in patients with medial osteoarthritis of knee joint， the changes of bone mineral density in proximal tibia were understood， and the rationality of the theory of "uneven settlement of knee joint" was further proved.

[Key words] Osteoarthritis; Uneven settlement; CT value; Tibial platform; Proximal fibular osteotomy

张英泽等[1]在2014年提出膝关节骨关节炎（KOA）的发病因素有可能是膝关节不均匀沉降所导致的，因此开展了近端腓骨截骨术治疗KOA，结果显示术后患者疼痛缓解及膝关节功能有很好的改善[2-4]。相关研究指出骨质疏松导致的膝关节不均匀沉降是KOA发生和发展的主要因素，骨密度和骨质量下降，骨微结构破坏，造成骨脆性增加，使得应力的传递与分散功能减弱，由于内侧平台没有腓骨支撑，导致胫骨平台内外侧沉降速率不均匀[5-8]。在“不均匀沉降理论”指导下，采用腓骨截骨术治疗以膝关节内侧或前内侧间室受累为主的KOA患者，可以明显降低患者疼痛并显著改善膝关节功能，然而对于症状严重者，也可有效延缓患者全膝关节置换[9-11]。本研究探讨腓骨近端截骨对胫骨近端CT值变化及骨密度影响，现报道如下。