内侧动态撑开骨痂延长法胫骨近端截骨术及疗效观察

Application and outcomes of open-wedge proximal tibial osteotomy with hemicallotasis

目的介绍动态撑开半侧骨痂延长截骨法(hemicallotasis osteotomy,HCO)在胫骨高位截骨中的应用,观察其临床疗效。方法应用HCO法对13例15膝行胫骨近端截骨,平均随访18.3个月(8～28个月),比较术前及术后不同时期胫股角(femur tibial angel,FTA)、机械力线偏移(migration of mechanical axis,%MA)、关节活动度(range of motion,ROM)和JOA(Japanese Orthopaedic Association)膝关节评分的差异。结果所有病例无严重并发症发生。外固定架使用时间平均为(51.6±11.2)d(46～65d),矫形时间(29.2±7.3)d(21～38d),矫正指数(7.1±2.5)d/度(3.3～12.1d/度)。与术前相比,拔钉后和最终随访时的FTA降低,%MA增加,差异有显著性(P<0.05)。拔钉后至随访结束时的FTA和%MA无明显改变(P>0.05)。术后JOA评分显著提高(P<0.05),ROM改变差异无显著性(P>0.05)。结论外固定架内侧动态骨痂延长截骨法胫骨近端截骨术是一种安全、准确、操作简单、并发症较少、疗效确切的治疗方法。

[Objective] To introduce the method of open-wedge proximal tibial osteotomy with hemicallotasis （HCO）, and investigate the therapeutic effects of HCO. [Method] Proximal tiblal osteotomy was performed to 13 patients （15 knees） with osteoarthritis or juvenile varus deformity by HCO method. All patients were followed up for an average of 18.3 months （ranged from 8 months to 2 years and 4 months）. The femur tibial angel （FTA）, migration of mechanical axis of lower extremities （%MA）, range of motion （ROM） and JOA knee scale were compared respectively. [Result] No severe complications occurred among all 15 knees. The average period of external fixation was （51.6±11.2）d （46-65 d）, modulation time was （29.2±7.3） d （21-38 d）, the healing index was （7.1±2.5） d/degree （3.3-12.1 d/degree）. Compared to preoperative state, the FTA was obviously decreased and %MA raised at the removal of the pins and at the end of follow-up （P 〈0.05）. The correction of FTA and %MA was well maintained after the pins were removed. The postoperative JOA knee scale was significandy improved （P〈0.05）, but the ROM of pre- and postoperation had no statistic difference （P〉0.05）. [Conclusion] Proximal tibial osteotomy with hemica[lotasis is a safe, easy to perform and control method, which shows less complications and reliable curative effects.