小切口开放胫骨高位截骨治疗膝内侧骨关节炎

Treatment of medial unicompartmental knee osteoarthritis with open-wedge high tibial osteotomy through small incision

目的:观察小切口开放楔形胫骨高位截骨术治疗膝内侧室骨关节炎的效果。方法:2000～2003年,对28例(40膝)膝内侧室骨关节炎患者采用小切口开放楔形胫骨高位截骨术治疗。手术采用胫骨结节外侧约5～6cm纵弧形切口和胫骨结节内侧2cm纵切口,骨膜下充分暴露胫骨结节至关节面间胫骨,根据术前测量的截骨角度在距关节面约2cm处开放楔形截骨,然后将胫骨远端于轻度内旋前移位与近端对合并用胫骨平台外侧支持钢板内固定。结果:随访12～55个月(平均30个月),通过X线片及膝关节功能评定,其优良率为90%。结论:小切口开放楔形胫骨高位截骨术治疗膝内侧室骨关节炎符合生物力学,可降低胫骨后倾角度减小、髌骨低位、胫骨骨量丢失等问题的发生率,延缓骨关节炎的发展,早中期疗效满意。

Objective:To study the results of treatment of medial unicompartmental knee osteoarthritis with open-wedge high tibial osteotomy through small incision.Method:From 2000 to 2003,a total of 40 knees of 28 patients with medial unicompartmental knee osteoarthritis were treated with open-wedge high tibial osteotomy through small incision.There were 8 male (10 knees)and 20 female (30 knees)patients with the average age of 56 years ranging from 42 to 70 years.The tibia was exposed from tibial tubercle to articular surfaces through small lateral and medial incisions.The open-wedge osteotomy line was 2cm distal to articular surfaces,and the tibia was fixed with buttress“T” plate simultaneously with rotation and elevation of the distal tibia.Result:Follow-up had been done for 12 to 55 months with the mean time of 30 months.According to the results of X-ray and functional evaluation,the excellent rate had reached 90%.Conclusion:It is in accordance with biomechanics to treat medial unicompartmental knee osteoarthritis with open-wedge high tibial osteotomy through small incision.And it seldom leads to such complications as patellar baja,the loss of tibial posterior slope angle.So,the treatment has a satisfactory result.