中国修复重建外科杂志

中国修复重建外科杂志

开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察

查看全文

目的 探讨开放楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)治疗膝关节内侧间室骨关节炎的效果。 方法 回顾分析 2015 年 1 月—2017 年 1 月采用 OWHTO 治疗的 61 例膝关节内侧间室骨关节炎患者临床资料。男 14 例,女 47 例;年龄 44~60 岁,平均 52.8 岁。体质量指数为 19.1~34.7 kg/m2,平均 25.3 kg/m2。左膝 27 例、右膝 34 例。病程 1~9 年,平均 5.3 年。骨关节炎分期:Ⅱ期 33 例,Ⅲ期 28 例。术前膝关节美国特种外科医院(HSS)评分为(56.0±3.7)分,行走时膝关节疼痛视觉模拟评分(VAS)为(4.6±1.0)分。 结果 手术时间为 49~85 min,平均 66.5 min;切口长度为 10~13 cm,平均 11.0 cm;总显性失血量为 80~210 mL,平均 139.1 mL;术后卧床时间为 1~10 d,平均 4.7 d。患者均获随访,随访时间 12~24 个月,平均 17.3 个月。术后 3 个月 X 线片测量示胫骨平台负重区为 60.3%~66.8%,平均 63.4%。术后 3、6 个月,膝关节 HSS 评分分别为(79.1±4.2)、(85.3±3.1)分,VAS 评分分别为(1.7±0.7)、(0.6±0.5)分,差异均有统计学意义(P<0.05)。 结论 OWHTO 治疗膝关节内侧间室骨关节炎疗效确切,力线纠正理想,并发症较少,但应注意术前需要精确测量术中张开角。

Objective To evaluate the effectiveness of open wedge high tibial osteotomy (OWHTO) in treatment of medial unicompartmental knee osteoarthritis (MUKOA). Methods A clinical data of 61 cases with MUKOA who were treated with OWHTO between January 2015 and January 2017 were retrospectively analyzed. There are 14 males and 47 females with an average age of 52.8 years (mean, 44-60 years). The body mass index ranged from 19.1 to 34.7 kg/m2 (mean, 25.3 kg/m2). Twenty-seven cases were left side and 34 cases were right side. The disease duration was 1-9 years (mean, 5.3 years). The MUKOA was rated as stage Ⅱ in 33 cases and stage Ⅲ in 28 cases. Preoperative Hospital for Special Surgery (HSS) score was 56.0±3.7. Walking visual analogue scale (VAS) score was 4.6±1.0. Results The operation time was 49-85 minutes (mean, 66.5 minutes). The length of incision was 10-13 cm (mean, 11.0 cm). The total overt blood loss was 80-210 mL (mean, 139.1 mL). The postoperative bed-rest time was 1-10 days (mean, 4.7 days). All patients were followed up 12-24 months (mean, 17.3 months). The bearing area of tibial platform at 3 months after operation was 60.3%-66.8%, with an average of 63.4%. At 3 and 6 months after operation, the HSS score was 79.1±4.2 and 85.3±3.1 respectively, and the VAS score was 1.7±0.7 and 0.6±0.5 respectively, all showing significant differences (P<0.05). Conclusion OWHTO is an ideal choice for treating MUKOA with less postoperative complications. The force line could be corrected by OWHTO. However, the preoperative preparations are very important, especially that the open angle should be measured accurately.

关键词: 开放楔形胫骨高位截骨; 膝关节内侧间室; 骨关节炎

Key words: Open wedge high tibial osteotomy; medial unicompartment of knee; osteoarthritis

引用本文: 张子琦, 梁佳林, 樊立宏, 时志斌, 党晓谦, 王坤正. 开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察. 中国修复重建外科杂志, 2018, 32(8): 997-1000. doi: 10.7507/1002-1892.201802015 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Jackson JP. Osteotomy for arthritis of the knee. J Bone Joint Surg (Br), 1958, 40: 826-836.
2. Zuiderbaan HA, Van der List JP, Kleeblad LJ, et al. Modern inications, results, and global trends in the use of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of isolated medial compartment osteoarthritis. Am J Orthop (Belle Mead NJ), 2016, 45(6): E355-E361.
3. Mancuso F, Hamilton TW, Kumar V, et al. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 112-122..
4. Hernigou P, Medeveielle D, Debeyer J, et al. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg (Am), 1987, 69(3): 332-354.
5. White SH, Ludkowski PF, Goodfellow JW, et al. Anteromedial osteoarthritis of the knee. J Bone Joint Surg (Br), 1991,73(4): 582-586.
6. Robinson BJ, Rees JL, Price AJ, et al. A kinematic study of lateral unicompartmental arthroplasty. Knee, 2002, 9(3): 237-240.
7. Rodriguez-Merchan EC. Unicompartmental knee osteoarthritis (UKOA): unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO)? Arch Bone Jt Surg, 2016, 4(4): 307-313.
8. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
9. Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits. Joints, 2016, 4(2): 98-110.
10. Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2017, 137(7): 903-911.
11. Goshima K, Sawaguchi T, Shigemoto K, et al. Patellofemoral osteoarthritis progression and alignment changes after open-wedge high tibial osteotomy do not affect clinical outcomes at mid-term follow-up. Arthroscopy, 2017, 33(10): 1832-1839.
12. Kim CW, Seo SS, Lee CR, et al. Factors affecting articular cartilage repair after open-wedge high tibial osteotomy. Knee, 2017, 24(5): 109-1107.
13. Nakamura R, Komatsu N, Fujita K, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J, 2017, 99-B(10): 1313-1318.
14. Slevin O, Ayeni OR, Hinterwimmer S, et al. The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(11): 3584-3598.
15. Han JH, Kim HJ, Song JG, et al. Is bone grafting necessary in opening wedge high tibial osteotomy? A Meta-analysis of radiological outcomes. Knee Surg Relat Res, 2015, 27(4): 207-220.
16. Lee OS, Lee KJ, Lee YS. Comparison of bone healing and outcomes between allogenous bone chip and hydroxyapatite chip grafts in open wedge high tibial osteotomy. J Mater Sci Med, 2017, 28(12): 189-197.
17. Kim JI, Kim BH, Lee KW, et al. Lower limb length discrepancy after high tibial osteotomy: prospective randomized controlled trial of lateral closing versus media ppening wedge osteoromy. Am J Sports Med, 2016, 44(12): 3095-3102.