外侧闭合楔形胫骨近端截骨术的远期疗效分析(英文)

Survivorship of lateral closing wedge proximal tibial osteotomy

[目的]探讨胫骨近端截骨术治疗原发性胫骨近端骨性关节炎的远期疗效以及最佳的截骨矫正角度。[方法]自1985～1997年，79例（111膝）原发性骨性关节炎患者接受了胫骨近端截骨术。其中男5例（5膝），女74例（106膝）；年龄37～70岁（平均55岁）。根据术后胫股角（FTA）分为3组。Ⅰ组61膝FTA〈7°；Ⅱ组23膝FTA7°～9°；Ⅲ组27膝FTA≥10°。所有病例术前、术后按特种外科医院评分系统（HSS）评分。[结果]术后随访2年4个月～14年1个月（平均9年6个月）。术前HSS平均60分，术后1年平均94分，末次随访平均87分。采用2种方法判定手术失败：方法1为需行人工全膝关节置换术者，随访4年和14年手术成功率分别为99％和85％；方法2为需行人工全膝关节置换术者或术后HSS评分〈60分，随访4年和14年手术成功率分别为96．4％和75．1％。[结论]胫骨近端截骨术是治疗单间室骨性关节炎的有效方法，但术后胫股角应矫正到外翻7°以上（范围10°～15°）。

[ Objective] To determine the long term survivorship and establish the idea 1 correction angle in proximal tibial osteotomy for primary osteoarthritis. [ Method] Seventy -nine patients suffering from primary osteoarthritis （111 knees） were performed with proximal tibial valgus osteotomy from 1985 to 1997, among which 74 women （ 106 knees） and 5 men （5 knees） . The age ranged from 37 to 70 years （mean, 55 years） . Postoperatively, hospital for Special Surgery knee score （HSS） was used for clinical assessment. The femorotibial angle （FTA） was measured to classifiy patients to group Ⅰ of 61 knees with less than 7 of valgus; group Ⅱ of 23 knees with 7～9 of valgus; group Ⅲ of 27 knees with over 10 of valgus. Closed wedge osteotomy was performed in all cases. HSS was assessed pro - and post - operatively. [ Result] The average follow - up period was 9 years and 6 months （2 years and 4 months to 14 years and 1 month） . The HSS knee score averaged 60 points preoperatively, 94 after 1 year and 87 at the last follow - up. Falure Ⅰ was the need for conversion of a proximal tibial osteotomy to a total knee arthrop lasty, and Failure Ⅱ was the need for conversion of HSS knee score of less than 60points. The 4 and 14 years survival rates were 99% and 85% using the first definition of failure, and 96.4% and 75. 1% using the second. [ Conclusion] Proximal tibial osteotomy is reliable for treating unicompartmental osteoarthritis, providing that the postoperative femorotibial angle is corrected to more than 7° of valgus and falls in the range of 10° - 15°.March