下肢机械力线改良精准对线方法在开放楔形胫骨高位截骨术中的应用研究

发布时间：2018-01-24 16:10

本文关键词： 膝关节骨关节炎开放楔形胫骨高位截骨术下肢机械力线　出处：《中国修复重建外科杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨采用下肢机械力线改良精准对线方法行开放楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)治疗膝关节骨关节炎的疗效。方法回顾分析2012年1月—2015年12月收治并符合选择标准的62例(68膝)接受OWHTO的膝关节内侧单间室骨关节炎患者临床资料。其中,2012年1月—2014年3月共29例(32膝)患者术中采用传统方法定位下肢机械力线(传统组),2014年4月—2015年12月共33例(36膝)患者术中采用改良方法定位下肢机械力线(改良组)。两组患者性别、年龄、侧别、病程、骨关节炎分级等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组手术时间、术中透视次数、术中失血量;手术前后摄双下肢全长X线片,观测术侧下肢机械力线,以髋膝踝角(hip-knee-ankle angle,HKA)表示;采用美国特种外科医院(HSS)评分、美国西部Ontario与Mc Master大学骨关节炎指数评分(WOMAC)评价临床疗效。结果术后传统组1例截骨部位切口发生血肿,经对症处理后3周愈合;其余患者术后切口均Ⅰ期愈合,无早期并发症发生。改良组手术时间、术中透视次数,均低于传统组(t=11.934,P=0.000;t=11.663,P=0.000);但两组术中失血量比较,差异无统计学意义(t=0.209,P=0.835)。两组患者均获随访,其中传统组随访时间6~24个月,平均12.7个月;改良组随访时间3~22个月,平均13.2个月。患者膝关节内侧间隙疼痛症状均消失。末次随访时,两组HSS评分以及WOMAC评分与术前比较,差异均有统计学意义(P0.05);两组间比较,差异均无统计学意义(P0.05)。术后X线片复查示,两组患者股胫角均得到纠正。两组术后即刻及末次随访时HKA角较术前提高(P0.05);术后两时间点间比较,差异无统计学意义(P0.05)。结论与传统下肢机械力线定位方法相比,OWHTO术中采用下肢机械力线改良精准对线方法,可减少术中透视次数、缩短手术时间,减少了医患双方辐射暴露。
[Abstract]:Objective to investigate the open wedge high tibial osteotomy with open wedge-shaped high tibial osteotomy with improved and accurate alignment of mechanical force line of lower extremity. The curative effect of OWHTO) on knee osteoarthritis methods 62 cases (68 knees) treated with OWHTO from January 2012 to December 2015 were retrospectively analyzed. Clinical data of patients with medial single compartment osteoarthritis of knee joint received OWHTO. From January 2012 to March 2014, a total of 29 patients with 32 knees were treated with traditional method to locate the mechanical line of lower extremity (traditional group). From April 2014 to December 2015, 33 patients with 36 knees were treated with improved method to locate the mechanical line of lower extremity (modified group). Sex, age, side and course of disease were used in both groups. Compared with the general data of osteoarthritis, the difference was not statistically significant (P 0.05). The operation time, the times of fluoroscopy and the amount of blood loss in the two groups were recorded. The full-length X-ray films of both lower limbs were taken before and after operation, and the mechanical force lines of the lower extremities were observed, as indicated by hip and knee ankle angle hip-knee-ankle angle HKA. HSS score was used in the United States Special surgery Hospital. Ontario and MC Master University Osteoarthritis Index (Osteoarthritis Index) were used to evaluate the clinical efficacy. Results hematoma occurred in the incision of osteotomy in one case in the traditional group after operation. 3 weeks after symptomatic treatment; In the other patients, all the incisions healed in the first stage, and no early complications occurred. The operation time and the times of fluoroscopy in the modified group were lower than that in the traditional group (11.934 and 0.000). T ~ (11. 663) P ~ (1) 0.000 ~ (-1); However, there was no significant difference in blood loss between the two groups during operation. The patients in both groups were followed up for 6 ~ 24 months. An average of 12.7 months; The patients in the modified group were followed up for 3 ~ 22 months with an average of 13.2 months. The symptoms of pain in the medial space of the knee disappeared. At the last follow-up, the HSS score and the WOMAC score of the two groups were compared with those before operation. The difference was statistically significant (P 0.05). There was no significant difference between the two groups (P 0.05). The femoral tibial angle was corrected in both groups. The HKA angle was increased immediately after operation and at the last follow-up in both groups than that before operation (P 0.05). There was no significant difference between the two time points after operation (P 0.05). Conclusion compared with the traditional positioning method of mechanical force line of lower extremity, OWHTO adopts improved alignment method of mechanical force line of lower extremity. It can reduce the times of intraoperative fluoroscopy, shorten the operation time and reduce the radiation exposure of both doctors and patients.
【作者单位】：西安交通大学附属红会医院关节外科膝关节病区;西安交通大学附属红会医院手术麻醉一科;
【分类号】：R687.3
【正文快照】： 膝关节骨关节炎治疗经过多年研究,在理念和BMI)30;(7)X线片检查确诊骨关节炎,Ahlback技术上均取得了巨大进步。对于活动量大、单间分级≤Ⅱ级[1-3]。排除标准:(1)术前膝关节活动室、症状较重且保守治疗无效的中青年患者,开放120°,屈曲畸形10°;(2)胫骨内外侧关节面形成楔

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