胫骨高位截骨术张力带钢丝内固定的临床观察

Clinical observation of high tibial osteotomy and tension band wiring

目的探讨胫骨高位楔形截骨术后张力带钢丝内固定效果。方法对36例膝关节内翻畸形患者采用胫前外侧入路、胫骨结节上楔形截骨、矫正畸形、张力带钢丝内固定。测定术前术后关节间隙距离、FTA角、Mikritz线和JOA评分,观察骨折愈合时间。结果术后平均随访6个月。JOA评分由术前平均65·4分±8·9分提高到73·9分±11·3分;Mikritz线由术前35·7%提高到49·6%;FTA角术前181°,术后为175°;术前JOA、Mikritz线和FTA与术后比较差异有显著性(P<0·05);关节间隙距离术前、术后差异无显著性(P>0·05)。手术后3个月截骨面愈合,无假关节形成。结论胫骨结节高位截骨张力带钢丝内固定治疗伴膝内翻的中老年膝关节骨性关节炎可达到坚强内固定,且固定简单,效果可靠。

Objective To investigate the effect of high tibial osteotomy and tension band wiring. Methods 36 cases with knee varus were undergone tibia osteotomy on the level of tuberosity to correct deformities and tension band wiring through anterior lateral approach. The pre-and postoperative joint spaces, FTA, Mikritz lines and JOA scores were measured, and osteotomy healing was observed. Results All cases were followed up for 6 months on average. JOA scores were 65.4 ± 8.9 and 73.9 ± 11.3 pre-and postoperatively, with Mikritz lines 35.7% and 49. 6%, and FTA 181 ° and 175°, The differences of JOA scores, FTA and Mikritz lines were significant （P 〈 0. 05 ）, and that of joint spaces was not significant （ P 〉 0. 05 ）. All got bony union in 3 months postoperatively. No pseudoarthrosis was found. Conclusions It can provide rigid fixation in the treatment of aged knee osteoarthritis with varus by high tibial osteotomy and tension band wiring, which is simple and effective.