胫骨内侧高位开放楔形截骨术治疗膝内侧间室骨性关节炎的疗效

Open-wedge high tibialosteotomy in the treatment of medial compartment osteoarthritis of the knee

目的评价应用胫骨内侧高位开放楔形截骨术治疗膝内侧间室骨性关节炎的方法和临床疗效。方法选取2015年1月至2017年12月共16例膝内侧间室骨性关节炎合并膝内翻畸形的患者,使用胫骨高位内侧楔形开放截骨锁定钢板内固定术治疗,术前术后测量并评估胫骨近端内侧角,股胫角及膝关节评分(HSS评分)、视觉模拟评分(VAS),统计术后并发症情况。结果 16例患者随访时间为3~28(11.6±3.3)个月。与术前比较,末次随访时HSS膝关节评分升高,VAS评分降低,差异有统计学意义(P<0.01);术后3个月股胫角减小,胫骨近端内侧角增大,差异有统计学意义(P<0.01)。患者术后2周部分负重,术后6周完全负重行走,伤口均愈合,无副损伤。结论胫骨高位楔形截骨内侧撑开锁定接骨板内固定术能够获得优良的膝关节初始稳定性,并纠正膝关节内翻畸形、重建下肢力线,术后近期疗效满意。

Objective To evaluate the method and clinical efficacy of open wedge high tibialosteotomy(HTO) in the treatment of medial compartment osteoarthritis of the knee.Methods Sixteen patients with medial compartment osteoarthritis combined with varus deformity of the knee treated with HTO and locking plate internal fixation from January 2015 to December 2017 were enrolled.Medial proximal tibial angle(MPTA),femorotibial angle(FTA),Hospital Special Surgery Knee Score(HSS-KS) and visual analogue scale(VAS) were measured and evaluated before and after operation.Posterior complications were observed.Results The follow-up time ranged from 3 to 28(11.6 ± 3.3) months for 16 patients.Compared with pre-operation,HSS-KS score increased,and VAS score decreased at the last follow-up after operation(P<0.01),and MPTA and FTA increased 3 months after operation(P<0.01).The patients were partially loaded at 2 weeks after operation and walked completely with fully loading at 6 weeks after operation.The wounds healed,and there were no evidences of serious side effects in patient.Conclusion HTO and locking plate internal fixation can obtain excellent initial stability of knee joint,correct varus deformity of knee joint and reconstruct lower limb force line.The short-term effect is satisfactory after operation.