静脉曲张合并膝骨关节炎联合手术治疗的初步体会

O. Nematzoda, A. Gaibov, O. F. Soliev, KH.A. Toshpulotov, S. Ali-Zade, A. Baratov
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引用次数: 1

摘要

目的:分析下肢隐静脉曲张合并膝关节骨性关节炎同期手术治疗的临床经验。方法:对静脉曲张(VV)患者同时行静脉切除联合膝关节镜手术的结果进行分析。共纳入15例女性患者(平均年龄52.8±1.9岁)。根据1994年发表的慢性静脉疾病临床病因解剖病理生理学(CEAP)分类,5例患者为临床II级,10例为III级。13例(86.7%)伴有双侧隐静脉扩张;12例患者同时出现大隐静脉(GSV)和小隐静脉(SSV)扩张。5例患者存在穿支静脉功能不全。根据Kellgren和Lawrence系统(1957)的OA分类,5例患者的临床和实验室结果为КOA II级,10例患者为III级。超重9例,平均体重77.5±3.8 kg。根据Lequesne's算法功能指数(AFI)评估术前和术后3个月膝关节功能。结果:GSV和SSV的平均内径分别为10.2±0.4和6.4±0.4 mm,未穿孔静脉的平均内径为4.1±0.3 mm。手术前踝围为37.7±1.5 cm。在所有病例中,患者在夜间(n=5有运动,n=10没有运动)、晨僵(n=9)、行走一定距离时(n=8)或运动开始时(n=7)疼痛和不适加重。疼痛不适与年龄(r=0.53)、KOA分期(r=0.70)、踝围(r=0.58)呈正相关,与体重(r=-0.55)、VV复发(r=-0.68)呈负相关。所有患者都抱怨行走困难,因此,他们的步行距离缩短了。步行距离与体重(r=0.71)、KOA分期(r=0.84)、踝围(r=0.81)、夜间疼痛和不适(r=0.66)直接相关。此外,在所有病例中,患者的日常生活活动都有所减少,包括上下一段楼梯的能力、蹲或跪的能力,以及在不平坦的地面上行走的能力有限。联合手术第一步(静脉切除术)和膝关节镜手术的平均手术时间分别为125.5±25.5分钟和58.2±10.5分钟。术后创面出现血肿仅1例。平均住院时间为7.2±1.2 d, 10 ~ 12 d内拆线。术后1个月和3个月随访,Lequesne’s AFI及踝围均明显下降至32.0±1.3 cm。结论:静脉切除术联合关节镜膝关节手术治疗VV合并KOA患者可显著改善症状性KOA患者的步行距离和日常活动量增加,无明显并发症。关键词:静脉曲张,膝关节骨关节炎,静脉切除术,静脉剥离,膝关节镜手术,联合手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
EVALUATION OF RESULTS OF THE FIRST EXPERIENCE OF COMBINED SURGERY FOR VARICOSE VEINS AND KNEE OSTEOARTHRITIS
Objective: To analyze the results of the first experience of performing simultaneous operations for saphenous varicose veins of the lower extremities and knee osteoarthritis. Methods: The results of simultaneously performed combined phlebectomy and arthroscopic knee surgery in patients with varicose veins (VV) were analyzed. A total of 15 female patients (mean age 52.8±1.9 years) were included in the study. In 5 patients, Clinical Class II, according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification, published in 1994 for chronic venous disease, was noted, and in 10 – class III. In 13 (86.7%) cases, there was a bilateral dilatation of the saphenous veins; and in 12 patients, there was a combined dilatation of both the Great Saphenous Vein (GSV) and Small Saphenous Vein (SSV). Perforator venous insufficiency was present in 5 patients. Among those examined, in 5 cases, clinical and laboratory findings of the КOA grade II, according to the Kellgren and Lawrence system (1957) for OA classification, were noted, and in 10 patients – grade III. Overweight was observed in 9 patients, and the mean weight was 77.5±3.8 kg. Assessment of the function of the knee joints before and three months after the operation was carried out according to Lequesne's algo-functional index (AFI). Results: The mean diameter of the GSV and SSV was 10.2±0.4 and 6.4±0.4 mm, respectively, and the diameter of insufficient perforating veins was 4.1±0.3 mm. The malleolar circumference before surgical treatment was 37.7±1.5 cm. In all cases, patients had pain and discomfort during the night (n=5 with movement and n=10 without), morning stiffness (n=9), and increased pain when walking a certain distance (n=8) or at the beginning of the movement (n=7). A positive correlation was found between pain and discomfort with age (r=0.53), KOA stage (r=0.70), malleolar circumference (r=0.58) and a negative correlation with body weight (r=-0.55) and recurrence of VV(r=-0.68). All patients complained of walking difficulties, and as a result, their walking distance was reduced. A direct correlation was found between walking distance and body weight (r=0.71), KOA stage (r=0.84), malleolar circumference (r=0.81), pain and discomfort during the night (r=0.66). In addition, in all cases, there was a decrease in daily life activities – the ability to climb one flight of stairs up or down at a moderate effort, squatting or kneeling, and limited ability to walk on uneven ground. The mean operative time of the combined operation's first step (phlebectomy) and arthroscopic knee surgery was 125.5±25.5 and 58.2±10.5 minutes, respectively. The development of postoperative seroma in the wound area was observed in only one case. The average hospital stay was 7.2±1.2 days, and sutures were removed within 10-12 days. A follow-up examination of patients after 1 and 3 months revealed a significant decrease in all the above parameters of Lequesne's AFI and malleolar circumference to 32.0±1.3 cm. Conclusion: Combined phlebectomy with arthroscopic knee surgery in VV comorbid with KOA results in a significant improvement in symptomatic KOA patients with increased walking distance and daily activity with no significant complications. Keywords: Varicose veins, knee osteoarthritis, phlebectomy, vein stripping, arthroscopic knee surgery, combined operations.
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