胫骨高位截骨治疗膝骨性关节炎的中长期疗效分析

发布时间：2018-08-11 19:31

【摘要】：目的:分析胫骨高位截骨术治疗膝关节骨性关节炎的中长期疗效。方法:自2001年1月至2005年12月,采用胫骨高位截骨术治疗45例63膝关节内侧间室骨性关节炎患者,其中男性患者10例(15膝),女性患者35例(48膝),年龄45-64岁,平均(54.76±5.54)岁。术前常规行膝关节负重正侧位X线检查,准确测量股胫角大小,根据术前股胫角决定胫骨外侧截骨量,手术均在硬膜外麻醉下常规行胫骨高位截骨术,大部分行腓骨中段截骨,部分病例行上胫腓关节松解,术后第2天即行功能锻炼,2周开始无负重下床活动,术后8-10周开始负重。术后第2天、8-10周、半年、1年及以后每年1次拍片复查,对全部病例术前、术后3-5年、术后10-14年进行视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)和美国膝关节协会评分(KSS)评价膝关节疼痛、畸形、功能和运动范围。并对50膝关节采用单髁置换术治疗膝骨性关节炎患者的HSS、KSS评分比较做统计学分析。结果:43例(61膝)进行了10年及以上的随访,全部病人手术切口Ⅰ期愈合,术后8-10周截骨处均达骨性愈合。术后10-14年HSS评分平均76.24±5.27,优27膝,良25膝,可7膝,差2膝。术前与术后3-5年、术前与术后10-14年VAS、HSS、KSS比较有差异,术后3-5年与术后10-14年各项评分无明显差异。与UKA对照组的HSS、KSS评分比较无明显差异。结论:胫骨高位截骨治疗膝关节骨性关节炎(内侧间室关节炎)只要手术指征掌握适当,术后积极锻炼,其中长期疗效满意。
[Abstract]:Objective: to analyze the long-term effect of high tibial osteotomy on knee osteoarthritis. Methods: from January 2001 to December 2005, 45 cases (15 knees) were treated with high tibial osteotomy, including 10 male (15 knees) and 35 female (48 knees), aged 45-64 years (mean 54.76 卤5.54). X ray examination of knee joint loading and lateral position was performed before operation, the size of femoral tibial angle was measured accurately, and the amount of lateral tibia osteotomy was determined according to the preoperative femoral tibial angle. High tibial osteotomy was performed under epidural anesthesia, and fibula osteotomy was performed in most cases. In some cases, the upper tibiofibular joint was loosened, and the second day after operation, the functional exercise was carried out for 2 weeks, and the weight was carried out from 8 to 10 weeks after operation. The second day after operation was 8-10 weeks, half a year, one year and one year thereafter. All cases were examined before and after operation for 3-5 years. Visual analogue scale (VAS),) and American knee Association score (KSS) were performed 10-14 years after operation to evaluate knee pain, deformity, function and motor range. The HSS KSS scores of 50 patients with knee osteoarthritis treated by single condylar replacement were statistically analyzed. Results 43 cases (61 knees) were followed up for 10 years or more. All the patients were healed at the first stage of the incision. The osteotomy was achieved at 8 to 10 weeks after operation. The average HSS score was 76.24 卤5.27, excellent in 27 knees, good in 25 knees, fair in 7 knees and poor in 2 knees. There were significant differences between preoperative and postoperative 3-5 years, preoperative and postoperative 10-14 years in VAS-HSS-KSS, but there was no significant difference between 3-5 years after operation and 10-14 years after operation. There was no significant difference between HSS and KSS scores in UKA control group. Conclusion: the treatment of knee osteoarthritis (medial compartment arthritis) with high tibial osteotomy is satisfactory in the medium and long term as long as the operative indications are properly grasped and active exercise is taken after the operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】