中国修复重建外科杂志

中国修复重建外科杂志

双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎

查看全文

目的 探讨双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎的疗效。 方法 回顾分析 2014 年 1 月—2017 年 1 月采用双平面胫骨高位截骨术治疗的 65 例膝关节内侧间室骨关节炎患者临床资料。男 28 例,女 37 例;年龄 46~75 岁,平均 53.2 岁。左膝 30 例,右膝 35 例。病程 3~7 年,平均 4.0 年。患者均有不同程度膝关节内侧疼痛,行走困难。膝关节内侧挤压试验阳性。术后采用膝关节美国特种外科医院(HSS)评分以及膝关节学会评分系统(KSS)临床及功能评分评估膝关节功能,疼痛视觉模拟评分(VAS)评价疼痛程度。随访期间摄 X 线片,观察截骨愈合情况;测量股胫角(femur tibia angle,FTA)、胫骨后倾角(posterior tibial slope,PTS)、胫骨近端内侧角(medial proximal tibial angle,MPTA)以及膝关节内翻角(knee varus angle,KVA)。 结果 术后切口均Ⅰ期愈合;仅 1 例出现ル趾麻木,对症处理后症状消失。患者均获随访,随访时间 13~18 个月,平均 15.4 个月。X 线片复查示,术后 12 周时截骨处均达骨性愈合。术后各时间点 MPTA、FTA、PTS 及 KVA 与术前比较,差异均有统计学意义(P<0.05);术后 1 周、6 个月及 12 个月间比较,差异均无统计学意义(P>0.05)。随访期间内固定物无松动及断裂现象发生。术后 12 个月 HSS 评分以及 KSS 临床及功能评分均高于术前(P<0.05)。术后 1 周、6 个月及 12 个月 VAS 评分显著低于术前(P<0.05)。 结论 双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎,可有效缓解疼痛症状、改善关节功能。

Objective To investigate the effectiveness of double-plane high tibial osteotomy in treatment of medial compartment osteoarthritis. Methods The clinical data of 65 patients with medial compartment osteoarthritis who were treated with double-plane high tibial osteotomy between January 2014 and January 2017 was retrospectively analyzed. There were 28 males and 37 females. The age ranged from 46 to 75 years with an average of 53.2 years. There were 30 cases in the left knee and 35 cases in the right knee. The disease duration was 3-7 years (mean, 4.0 years). The patients had different degrees of pain in the knee joint and difficulty walking. The knee joint compression test was positive. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS) clinical and functional scores. The visual analogue scale (VAS) score was adopted to pain measurement. The healing of osteotomy was observed by X-ray films during follow-up; the femur tibia angle (FTA), posterior tibial slope (PTS), medial proximal tibial angle (MPTA), and knee varus angle (KVA) were also calculated. Results All the incisions healed by first intention after operation. Only 1 case had numbness of the toe, and the symptoms disappeared after symptomatic treatment. All patients were followed up 13-18 months with an average of 15.4 months. X-ray examination showed that all patients had bone healing at 12 weeks after operation. There were significant differences in MPTA, FTA, PTS, and KVA between pre- and post-operation (P<0.05). There was no significant difference in above parameters among 1 week, 6 months, and 12 months after operation (P>0.05). There was no loosening and rupture of the fixator during the follow-up. The HSS score and KSS clinical and functional scores at 12 months after operation were significantly higher than those before operation (P<0.05). The VAS scores at 1 week, 6 months, and 12 months after operation were significantly lower than that before operation (P<0.05). Conclusion Double-plane high tibial osteotomy for medial compartment osteoarthritis can effectively relieve pain symptoms and improve joint function.

关键词: 双平面胫骨高位截骨术; 内侧间室骨关节炎; 膝关节

Key words: Double-plane high tibial osteotomy; medial compartment osteoarthritis; knee

引用本文: 魏伟, 沈计荣. 双平面胫骨高位截骨术治疗膝关节内侧间室骨关节炎. 中国修复重建外科杂志, 2018, 32(11): 1406-1410. doi: 10.7507/1002-1892.201805037 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. 张英泽, 李存样, 李冀东, 等. 不均匀沉降在膝关节退变及内翻过程中机制的研究. 河北医科大学学报, 2014, 35(2): 218-219.
2. Webb M, Dewan V, Elson D. Functional results following high tibial osteotomy: a review of the literature. Eur J Orthop Surg Traumatol, 2018, 28(4): 555-563.
3. van Egmond N, Janssen D, Hannink G, et al. Biomechanical comparison of two different locking plates for open wedge high tibial osteotomy. J Orthop Sci, 2018, 23(1): 105-111.
4. 陈伟, 陈百成, 王飞, 等. 应用不同方法治疗膝关节骨性关节炎的对比研究. 河北医科大学学报, 2015, 36(5): 600-602.
5. Torres-Claramunt R, Pelfort X, Hinarejos P, et al. Pressure algometry is an excellent tool to measure knee pain relief after a closing-wedge high tibial osteotomy. Orthop Traumatol Surg Res, 2018, 104(2): 193-196.
6. Wu L, Lin J, Jin Z, et al. Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis. PLoS One, 2017, 12(2): e0171700.
7. 张子琦, 梁佳林, 樊立宏, 等. 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.
8. Sundararajan SR, Nagaraja HS, Rajasekaran S. Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures. Arthroscopy, 2017, 33(3): 586-594.
9. 熊福军, 贺西京, 冯宏伟, 等. 关节镜下胫骨高位截骨治疗早期膝骨关节炎并内翻畸形疗效观察. 现代中西医结合杂志, 2014, 23(4): 389-390.
10. 陈国仙, 李国山, 林宗锦, 等. 3-D打印技术辅助胫骨高位截骨术治疗膝内翻畸形骨关节炎的疗效观察. 中国修复重建外科杂志, 2016, 30(4): 407-411.
11. 张子琦, 王春生, 杨佩, 等. 直接前入路与后入路对人工全髋关节置换术后早期康复的影响比较. 中国修复重建外科杂志, 2018, 32(3): 329-333.
12. Stannard JT, Stannard JP. High tibial osteotomy following biologic replacement of the knee. J Knee Surg, 2017, 30(8): 764-768.
13. 裴保安, 吴立生, 张存华. 胫骨高位截骨术治疗膝关节内侧间室骨关节炎并内翻畸形一例. 中华关节外科杂志(电子版), 2016, 10(5): 577-579.
14. Shin YS, Sim HB, Yoon JR. Tibial nerve neuropathy following medial opening-wedge high tibial osteotomy-case report of a rare technical complication. Eur J Orthop Surg Traumatol, 2017, 27(4): 563-567.
15. Aglietti P, Buzzi R, Vena LM, et al. High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg, 2003, 16(1): 21-26.
16. 包学智, 赵蓬, 刘培来, 等. 胫骨内侧开放楔形高位截骨治疗膝关节内侧间室骨关节炎的短期疗效. 山东大学学报(医学版), 2016, 54(10): 85-89.
17. 赵允, 胡文晋, 黄竞敏, 等. 内侧撑开高位胫骨截骨术联合调整胫骨平台后倾角治疗屈曲受限型膝内翻骨关节炎的早期疗效. 中国修复重建外科杂志, 2018, 32(2): 157-161.
18. Hernigou P, Roussignol X, Flouzat-Lachaniette CH, et al. Opening wedge tibial osteotomy for large varus deformity with Ceraver resorbable beta tricalcium phosphate wedges. Int Orthop, 2009, 34(2): 191-199.
19. Tabrizi A, Soleimanpour J, Sadighi A, et al. A short term follow up comparison of genu varum corrective surgery using open and closed wedge high tibial osteotomy. Malays Orthop J, 2013, 7(1): 7-12.
20. 张德新, 陈德生, 马丽艳, 等. 关节镜探查清理+内侧开放撑开式胫骨高位截骨治疗膝关节内侧单间室骨性关节炎. 中国煤炭工业医学杂志, 2016, 19(8): 1161-1164.