胫骨高位截骨Giebel系统固定治疗老年人膝内翻畸形

High tibial osteotomy with Giebel system fixation for the elderly patients with varus knee.

目的探讨应用胫骨高位截骨术及Giebel系统内固定治疗老年患者膝内翻畸形的有效性和优势。方法对老年膝内翻患者16例26膝采用上述方法手术。患者术前内翻畸形平均12．5°,膝关节活动度大于90°,不伴有其他关节间室病变,膝关节稳定性无明显异常,膝关节症状以内侧间室疼痛为主。对患膝进行精确的胫骨高位截骨术并应用Giebel系统内固定截骨端。手术前后测量患者关节活动度的大小,进行Lysholm评分。术后对患者进行主观满意度调查。结果术后未出现钢板螺钉断裂及神经血管损伤;1例切口脂肪液化延迟愈合。截骨处至术后12～16周均骨性愈合。测量矫正角度平均12．4°。对16例随访平均21个月,随访期间X线检查,下肢力线维持在术后水平,内外侧关节间隙无明显退变加重。至随访终末时,手术效果优良率为87．5％,81．3％患者对手术效果表示满意。手术前后膝关节活动度无明显变化;Lysholm评分由术前的49．1分增至79．4分,内外关节间隙差由术前的4．7 mm减至0．6 mm,内翻角度由术前的12．5°减至0．2°,手术前后差异均有统计学意义(P<0．01)。结论胫骨高位截骨术Giebel系统固定可有效地治疗老年患者轻中度膝关节内翻畸形,其创伤较小,固定强度大,骨愈合率高。

Objective To assess the effectiveness and advantage of the high tibial osteotomy with Giebel system fixation on treating elderly varus knees. Methods Sixteen elderly patients with varus knee were selected. Preoperatively, the mean varus angle was 12.5°,the range of motion was larger than 90°; other space of the knee joint and the stability were relatively normal. The main symptom was the pain in medial part. Accurate high tibial osteotomy with Giebel system fixation was performed in 26 knees of these patients. Weight-bearing extremity X-ray testing, varus angle, mechanical axle and anatomical axle were measured preoperatively and postoperatively. Joint space discrepancy between lateral and medial joints, the range of motion, Lysholm score and patients＇ satisfactory degree were determined to evaluate the outcome of the treatment. Results The mean follow-up of 16 patients was 21 months. During this period, no vascular and nerve injury and no broken of the plate and screw were observed. All the osteotomy achieved bony healing. The corrected angle was 12.4°. The mechanism axle of the extremity was maintained at that level after operation during the follow-up and there was no aggravated degeneration of the joint space. The excellent rate of the treatment was 87.5°, and 81.3° of the patients were satisfied with the operation. No difference in the range of motion before and after operation was found, but the Lysholm score, joint space discrepancy between lateral and medial joint and varus angle were improved after the osteotomy. Conclusions The high tibial osteotomy with Giebel system fixateon can correct the senile varus knee effectively. The Giebel system has the advantages of minimal invasion, stronger intensity and higher healing rate.