膝关节骨关节炎合并膝内翻、胫骨高位截骨的治疗

High tibial osteotomy for osteoarthritis of the knee with genu varum

目的 观察胫骨高位截骨治疗合并内翻畸形的膝关节骨关节炎 (OA)近、远期疗效 ,确定远期良好疗效的最佳下肢力线及术后各不同阶段的临床效果。方法 术前对所有手术患者进行临床X线检查的综合评估 ,测量全下肢立位力线 ,确定矫正截骨角度 ,采用胫骨高位楔形截骨术矫正下肢力线 ,术后 1年、2年、5～ 9年按同一评估标准进行追踪观察。资料应用 χ2检验分析。 结果 随访结果参考窦宝信标准进行综合评定 ,术后 1年组优良率 98.2 8% ,2年组优良率 96 .0 8% ,5～ 9年组优良率 78.12 % ,手术最佳下肢力线为 182°～ 185°。结论 全下肢立位力线测量准确性高 ,可重复性好 ,胫骨高位楔形截骨术矫正下肢力线治疗合并内翻畸形的膝关节OA ,矫正角度易于掌握 ,截骨部位愈合好 ,近、远期疗效高 ,是单侧股 -胫关节病变为主的膝关节OA患者首选的治疗方法。

Objective To observe the results of high tibial osteotomy for the treatment of osteoarthritis of the knee with genu varum and determine the best weight bearing line of lower limbs. The clinical results of this procedure were also observed at different postoperative periods. Methods The general status of all patients were comprehensively evaluated clinically and radiologically. Their weight bearing lines of lower limbs were measured at standing positions in order to determine the angles of corrective osteotomy with high tibial osteotomy. The patients were followed up according to the same assessment criterion at one,two and five to nine year intervals. χ 2 test was used to evaluate the final outcome.Results Evaluation was done according to the criterions made by Dou Baoxin.The excellent and good result was 98.28%in the first postoperative year group,96.08%in the second postoperative year group and 78.13%in the five to nine year group.The best weight bearing line is 182-185 degree.Conclusion High tibial osteotomy, with advantages of easy correction of the weight bearing line high union rate, and good curative effects, is the best method of choise to treat the osteoarthritis of knee mainly involving unilateral femoral tibial joint compartment.