关节镜并胫骨高位截骨术治疗膝内翻骨关节炎

High tibial osteotomy and arthroscopic management for the treatment of varus gonarthrosis

目的探讨应用关节镜并胫骨高位截骨术治疗膝内翻骨性关节炎的效果及影响手术效果的部分临床因素。方法2003年1～7月采用关节镜并胫骨高位截骨术,治疗膝内翻骨性关节炎患者35例(42膝)。拍摄患膝站立负重位的X线片,对比观察术前和术后X线片的股骨胫骨角的改变。随访手术效果,HSS评分系统评价手术效果。结果随访1～2年,膝关节疼痛明显缓解,站立负重位X线片股骨胫骨角术后较术前减少[(171.8±2.59)度比(189.2±4.22)度],膝内翻畸形得到矫正。手术优良率为98%。结论关节镜清理术与胫骨高位截骨术联合使用可提高对膝内翻骨关节炎的治疗效果。

Objective To evaluate the effect of high tibial osteotomy combined with arthroscopic management for osteoarthritis of the knee.Methods 35 patients with osteoarthritis of the knee (11 male,24 female,mean age:53yr,42 knees) from January 2003 to July 2003 were operated by high tibial osteotomy and arthroscopic management.These patients were followed up for 1～2 years.The femorotibial angles were measured on the standing anteroposterior film of knee pre-and postoperation in order to compare their changes.Clinical efficacy was assessed according to the HSS knee score at the latest follow-up.Results The recent result showed that all the patients had relief of pain and symptoms.Clinical result was excellent and operation excellent rate was about 98%.The mean femorotibial angle was (189.2±4.22)° and(171.8±2.59)° preoperatively and postoperatively.Conclusion The operation procedure should follow these orders,firstly having arthroscopic evaluation especially in lateral compartment of the knee, then having arthroscopic debridement,afterwards having high tibial osteotomdy.The best results are obtained after high tibial osteotomdy in association with arthroscopic management.