内侧撑开胫骨高位截骨Tomofix内固定治疗膝内翻的初步观察

Medial opening-wedge high tibial osteotomy with Tomofix plate for the treatment of genu varum

目的探讨内侧撑开胫骨高位截骨结合Tomofix内固定治疗膝内翻畸形的手术方法及短期疗效。方法 2009年10月至2010年8月,采用内侧撑开胫骨高位截骨(open wedge high tibial osteotomy,OWHTO)结合Tomofix锁定钢板内固定治疗膝内翻9例10个膝关节。术前、术后、术后2个月、6个月行X线片检查测量胫骨平台后倾角、胫骨股骨角、Insall-Salvati指数、并行Lysholm功能评分。结果患者术后随访2-10个月,平均6.2个月。胫股角从术前185.8°±2.5°降至174.4°±2.7°,术前与术后胫骨平台后倾角、Insall-Salvati指数、Lysholm评分无明显差异,患者术后3-4周基本恢复负重行走,术后6个月截骨处均一期愈合,无感染、骨不愈合、膝关节不稳及神经损伤等并发症,终末随访无膝内翻复发,术后疼痛及行走功能改善显著。结论内侧撑开胫骨高位截骨Tomofix内固定操作较简单,创伤小,并发症少,对关节正常解剖影响较小,可作为治疗膝内翻畸形和单间室骨关节炎的有效方法之一。

Objective To evaluate the surgical methods and short-term efficacy of medial open wedge high tibial osteotomy （OWHTO） with Tomofix in treating genu varum. Methods From October 2009 to August 2010, 9 consecutive patients （10 knees） were treated with OWHTO TomoFix implant （Synthes）. Radiographic and clinical data were collected preoperatively as well as 2 and 6 months after surgery to measure posterior slope angle of tibial plateau, femorotibial angel; Insall-Salvati indices and Lysholm knee scale were applied to evaluate the knee function. Results All the patients were followed-up for 6.2 months in average （range, 2-10 months）. The femorotibial angle （FTA） decreased from 185.8°±2.5° preoperatively to 174.4°±2.7° postoperatively. There were no significant difference between pre- and post-operative posterior slope angle of tibial plateau, values of Insall-Salvati indices and Lysholm knee scale. Full weight-bearing walking was started three to four weeks after surgery. Healing by first intention at the osteotomy site was achieved in all patients six months after surgery. No complications like infection, bone nonunion, knee instability and neurotrosis were observed, nor were recurrence of genu varum and postoperative pain in the terminal follow-up. The walking function improved significantly. Conclnsions HTO with an open-wedge technique using the Tomofix implant has the characteristic of easy to operate, small trauma, less complications and little impacts on joints, which can be considered as one of the effective methods in treating genu varum and knee osteoarthritis in single compartment.