胫骨高位截骨治疗膝关节骨性关节炎临床疗效分析

发布时间：2018-09-18 21:35

【摘要】：目的探讨闭合性与开放性胫骨高位楔形截骨术治疗膝关节单间室骨性关节炎的疗效。方法笔者自1998-03—2008-05采用闭合性胫骨高位楔形截骨(CWHTO)治疗膝关节骨性关节炎并内翻畸形90例(95膝),与自2007-08—2012-07采用开放性胫骨高位楔形截骨(OWHTO)治疗的膝关节内侧间室骨性关节炎并膝内翻27例(30膝)进行比较。采用膝关节HSS评分、VAS评分对术后疗效进行评价,下肢力线通过手术前后下肢全长X线片胫股角(FTA)、下肢负重线比率(WBL)评估。结果 OWHTO组获得平均60(36~96)个月随访。OWHTO组术后1周内屈曲可达90°,术后膝关节活动度、VAS评分、HHS评分、FTA及WBL均优于术前,差异均有统计学意义(P0.05)。CWHTO组获得平均144(80~204)个月随访。CWHTO组患者长腿管型石膏管型外固定4周后,去除石膏固定行免负重关节功能锻炼2周,骨折愈合后逐渐负重行关节功能锻炼。术后膝关节活动度、VAS评分、HSS评分、FTA、WBL均优于术前,差异均有统计学意义(P0.05)。所有患者无感染、截骨不愈合或延迟愈合发生,无腓总神经神经损伤、股四头肌力量及髌骨轨迹改变,无下肢短缩等发生,但行CWHTO截骨患者有下肢静脉血栓形成、有平台骨折发生。结论 2种截骨均能通过恢复下肢力线,达到缓解关节疼痛、改善关节功能,对于早期单间室骨性关节炎有较好疗效,开放楔形截骨更有优势。
[Abstract]:Objective To investigate the effect of closed and open high tibial wedge osteotomy in the treatment of unicompartment osteoarthritis of the knee joint.Methods From March 1998 to May 2008, 90 cases (95 knees) of knee osteoarthritis complicated with varus deformity were treated with closed high tibial wedge osteotomy (CWHTO) and 90 cases (95 knees) of open high tibial wedge osteotomy from August 2007 to July 2012. Twenty-seven patients (30 knees) with medial compartment osteoarthritis and varus knee were treated with osteotomy (OWHTO). The curative effect was evaluated by HSS score and VAS score. The lower extremity force line was evaluated by full-length X-ray of tibiofemoral angle (FTA) and lower extremity load line ratio (WBL) before and after operation. Follow-up. OWHTO group within one week after surgery flexion can reach 90 degrees, postoperative knee joint mobility, VAS score, HHS score, FTA and WBL were superior to preoperative, the difference was statistically significant (P 0.05). CWHTO group received an average of 144 (80-204) months of follow-up. CWHTO group with long leg cast external fixation 4 weeks later, removal of plaster fixation of weight-free joint exercise 2. All patients had no infection, no osteotomy union or delayed union, no common peroneal nerve injury, quadriceps femoris strength and patellar track changes, no lower limb shortening. Conclusion Both of the two osteotomies can relieve joint pain and improve joint function by restoring lower limb force line. They are effective for early unicompartment osteoarthritis, and open wedge osteotomy is more advantageous.
【作者单位】：运城市中心医院关节外科;第四军医大学第二附属医院(唐都医院)骨科;
【分类号】：R687.4

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