2种关节镜清理术联合腓骨截骨术对早中期内翻型KOA患者凝血参数、步态参数的影响

于景川; 焦弘升

doi:10.16766/j.cnki.issn.1674-4152.004293

2种关节镜清理术联合腓骨截骨术对早中期内翻型KOA患者凝血参数、步态参数的影响

doi: 10.16766/j.cnki.issn.1674-4152.004293

于景川^,,
焦弘升

华北医疗健康集团峰峰总医院骨六科，河北邯郸 056200

基金项目:

河北省重点研发计划项目 2210382716D

详细信息

通讯作者:
于景川，E-mail：yjc1981-2000@163.com

中图分类号: R684.3 R687.4
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出版历程
- 收稿日期: 2024-12-27
- 网络出版日期: 2026-03-13

Effect of two kinds of arthroscopic debridement combined with fibular osteotomy on the coagulation parameters and gait parameters of patients with early-to-mid stage varus knee osteoarthritis

YU Jingchuan^,,
JIAO Hongsheng

Orthopedics Section 6, North China Medical and Health Group Fengfeng General Hospital, Handan, Hebei 056200, China

摘要

摘要: 目的探究2种关节镜清理术联合腓骨截骨术治疗早中期内翻型膝关节骨性关节炎(KOA)的应用价值。方法收集2021年1月—2023年1月华北医疗健康集团峰峰总医院收治的103例早中期内翻型KOA患者，根据手术方案分组，研究组52例行关节镜下有限清理术+腓骨截骨术，对照组51例行关节镜下广泛清理术+腓骨截骨术。比较2组围手术期指标、手术前后凝血参数[纤维蛋白原(FIB)、D-二聚体(D-D)、活化部分凝血活酶时间(APTT)]、功能恢复指标、并发症及膝关节功能优良率。结果研究组手术时间[(38.38±4.46)min vs. (72.74±7.18)min，t=29.235，P＜0.001]、住院时间[(4.55±0.78)d vs. (7.00±0.65)d，t=17.300，P＜0.001]短于对照组，术中出血量[(190.90±41.12)mL vs. (309.45±68.68)mL，t=10.652，P＜0.001]与术后3 d VAS评分[(2.10±0.35)分vs. (2.69±0.40)分，F=7.971，P＜0.001]低于对照组。研究组术后3 d凝血参数优于对照组(P＜0.05)。2组术后功能恢复指标、并发症、膝关节功能优良率比较差异均无统计学意义(P＞0.05)。结论腓骨截骨术联合关节镜下有限清理术治疗早中期内翻型KOA患者，能优化手术流程，减轻围手术期疼痛，促进病情恢复。
- 膝关节骨性关节炎 /
- 截骨术 /
- 关节镜 /
- 凝血参数 /
- 膝关节功能
Abstract: Objective To explore the application value of two kinds of arthroscopic debridement combined with fibular osteotomy for the treatment of early-to-mid stage varus knee osteoarthritis (KOA). Methods A total of 103 patients with early-to-mid stage varus KOA were collected from January 2021 to January 2023 at North China Medical and Health Group Fengfeng General Hospital. They were divided into two groups according to surgical plans. The study group of 52 patients underwent limited arthroscopic debridement and fibular osteotomy, while the control group of 51 patients underwent extensive arthroscopic debridement and fibular osteotomy. The perioperative indicators, complications, and excellent and good rate of knee joint function were compared between the two groups, as well as the coagulation parameters [fibrinogen (FIB), D-dimer (D-D), activated partial thromboplastin time (APTT)], functional recovery indicators before and after surgery. Results The operation time [(38.38±4.46) min vs. (72.74±7.18) min, t=29.235, P < 0.001] and hospitalization time [(4.55±0.78) d vs. (7.00±0.65) d, t=17.300, P < 0.001] of the study group were shorter than those of the control group. The intraoperative blood loss [(190.90±41.12) mL vs. (309.45±68.68) mL, t=10.652, P < 0.001] and postoperative 3-day VAS score [(2.10±0.35) points vs. (2.69±0.40) points, F=7.971, P < 0.001] were lower than those of the control group. The coagulation parameters of the study group were better than those of the control group 3 days after surgery (P < 0.05). There was no significant difference in postoperative functional recovery indicators, complications, and excellent and good knee joint function rates between the two groups (P>0.05). Conclusion The combination of fibular osteotomy and limited arthroscopic debridement for the treatment of early-to-mid stage varus KOA patients can optimize the surgical process, reduce perioperative pain, and promote disease recovery.
- Knee osteoarthritis /
- Osteotomy /
- Arthroscopy /
- Coagulation parameters /
- Knee joint function

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表 1 2组KOA患者围手术期指标比较(x±s)

Table 1. Comparison of perioperative indicators between the two groups of KOA patients (x±s)

组别	例数	手术时间(min)	术中出血量(mL)	住院时间(d)	VAS评分(分)
组别	例数	手术时间(min)	术中出血量(mL)	住院时间(d)	术前	术后3 d	术后1周
研究组	52	38.38±4.46	190.90±41.12	4.55±0.78	6.68±0.44	2.10±0.35^c	1.06±0.30^c
对照组	51	72.74±7.18	309.45±68.68	7.00±0.65	6.57±0.53	2.69±0.40^c	1.10±0.34^c
统计量		29.235^a	10.652^a	17.300^a	1.451^b	7.971^b	1.284^b
P值		＜0.001	＜0.001	＜0.001	0.184	＜0.001	0.373
注：^a为t值，^b为F值；与同组术前比较，^cP＜0.05。F_交互=22.713，F_时间=131.584，F_组间=14.385，均P＜0.001。

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表 2 2组KOA患者手术前后凝血参数比较(x±s)

Table 2. Comparison of coagulation parameters between the two groups of KOA patients before and after surgery (x±s)

组别	例数	FIB(g/L)			F值	P值
组别	例数	术前	术后3 d	术后1周	F值	P值
研究组	52	2.40±0.38	3.11±0.44^a	2.42±0.36	54.524	＜0.001
对照组	51	2.35±0.43	3.85±0.46^a	2.40±0.34	216.857	＜0.001
F值		0.626	8.344	0.290
P值		0.533	＜0.001	0.773

组别	例数	D-D(μg/L)			F值	P值
组别	例数	术前	术后3 d	术后1周	F值	P值
研究组	52	141.12±16.68	200.04±34.77^a	142.50±14.85	103.293	＜0.001
对照组	51	139.95±18.24	301.17±42.48^a	140.86±15.72	552.829	＜0.001
F值		0.340	13.233	0.544
P值		0.735	＜0.001	0.587

组别	例数	APTT(s)			F值	P值
组别	例数	术前	术后3 d	术后1周	F值	P值
研究组	52	20.22±3.33	18.76±2.15^a	20.14±3.56	3.703	0.027
对照组	51	21.08±2.89	17.17±2.00^a	20.63±2.95	33.260	＜0.001
F值		1.399	3.884	0.760
P值		0.165	＜0.001	0.449
注：与同组术前比较，^aP＜0.05。FIB，F_交互=9.437，F_时间=30.882，F_组间=11.352，均P＜0.001；D-D，F_交互=18.744，F_时间=88.933，F_组间=12.135，均P＜0.001；APTT，F_交互=18.744，P_交互＜0.001，F_时间=88.933，P_时间＜0.001，F_组间=12.135，P_组间=0.019。

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表 3 2组KOA患者手术前后功能恢复指标比较(x±s)

Table 3. Comparison of functional recovery indicators between the two groups of KOA patients before and after surgery (x±s)

组别	例数	膝关节伸直度(°)				F值	P值
组别	例数	术前	术后3个月	术后6个月	术后12个月	F值	P值
研究组	52	-13.38±3.41	-11.45±2.03^a	-6.68±1.66^ab	-3.44±1.24^abc	211.738	＜0.001
对照组	51	-12.94±4.08	-11.60±2.11^a	-7.08±1.72^ab	-3.50±1.03^abc	151.677	＜0.001
F值		0.597	0.369	1.207	0.268
P值		0.552	0.713	0.230	0.789

组别	例数	膝关节屈曲度(°)				F值	P值
组别	例数	术前	术后3个月	术后6个月	术后12个月	F值	P值
研究组	52	59.22±6.64	63.63±7.48^a	92.89±10.00^ab	118.18±13.34^abc	417.327	＜0.001
对照组	51	59.48±6.50	64.12±7.85^a	91.34±9.76^ab	116.99±14.48^abc	355.057	＜0.001
F值		0.202	0.326	0.800	0.436
P值		0.840	0.745	0.426	0.664

组别	例数	HSS评分(分)				F值	P值
组别	例数	术前	术后3个月	术后6个月	术后12个月	F值	P值
研究组	52	49.52±4.48	55.15±5.86^a	77.73±6.99^ab	90.05±4.97^abc	589.173	＜0.001
对照组	51	48.11±5.56	54.76±6.13^a	76.68±7.42^ab	88.92±5.53^abc	476.833	＜0.001
F值		1.424	0.332	0.743	1.096
P值		0.158	0.741	0.459	0.276
注：与同组术前比较，^aP＜0.05；与同组术后3个月比较，^bP＜0.05；与同组术后6个月比较，^cP＜0.05。膝关节伸直度，F_交互=12.477，P_交互＜0.001，F_时间=56.398，P_时间＜0.001，F_组间=3.577，P_组间=0.103；膝关节屈曲度，F_交互=10.537，P_交互＜0.001，F_时间=68.576，P_时间＜0.001，F_组间=2.539，P_组间=0.184；HSS评分，F_交互=12.573，P_交互＜0.001，F_时间=70.841，P_时间＜0.001，F_组间=2.733，P_组间=0.169。

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表 4 2组KOA患者并发症比较

Table 4. Comparison of complications between the two groups of KOA patients

组别	例数	切口感染 [例(%)]	下肢静脉血栓 [例(%)]	行走不便 [例(%)]	术区肿胀 [例(%)]	总发生率 (%)
研究组	52	0	0	1(1.92)	2(3.85)	5.77(3/52)
对照组	51	1(1.96)	1(1.96)	2(3.92)	4(7.84)	15.69(8/51)
注：2组并发症发生率比较, χ²=2.655，P=0.103。

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表 5 2组KOA患者膝关节功能优良率比较

Table 5. Comparison of the excellent and good rate of knee joint function between the two groups of KOA patients

组别	例数	优 [例(%)]	良 [例(%)]	可 [例(%)]	差 [例(%)]	优良率 (%)
研究组	52	16(30.77)	30(57.69)	6(11.54)	0	88.46(46/52)
对照组	51	13(25.49)	31(60.78)	4(7.84)	3(5.88)	86.27(44/51)
注：2组优良率比较，χ²=0.112，P=0.738。

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