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胫骨高位闭合截骨联合关节镜手术治疗膝关节内侧骨关节炎5年以上随访 被引量:16

Combined closing wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoarthri tis:clinical results at a minimum follow up for five years
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摘要 目的:探讨联合应用胫骨高位闭合外翻截骨和关节镜手术治疗膝内翻及内侧间室骨关节炎的价值.方法:自2005年10月至2007年6月,对25例符合纳入标准的内侧膝关节骨关节炎的患者,通过关节镜手术和胫骨高位闭合外翻截骨进行治疗.男11例,女14例,平均年龄53岁.术前HSS功能评分平均67.6±2.8,股骨胫骨角平均(185.54±1.11)°,胫骨近端外侧解剖角平均(96.54±0.52)°.术后采用HSS膝关节功能评分标准进行评分,并通过测量股骨胫骨角及胫骨近端外侧解剖角评估矫形效果.结果:手术均成功,没有严重并发症.所有患者获随访,时间为5~7年.术后1年HSS功能评分85.5±3.7,较术前提高(t=-33.135,P=0.000);末次随访HSS功能评分80.3±5.4,较术后1年降低(t=-13.215,P=0.000).术后1年股骨胫骨角平均(173.65±0.92)°,较术前降低(t=28.739,P=0.000);末次随访股骨胫骨角平均(174.34±0.53)°,较术后1年提高(t=2.331,P=0.048).术后1年胫骨近端外侧解剖角平均(87.32±0.33)°,较术前降低(t=37.264,P=0.000);末次随访平均(87.67±2.82)°,较术后1年提高(t=2.469,P=0.039).结论:严格掌握适应证是保证疗效的前提,精确的手术技术是保证疗效的关键.术前计划和术中的力线观察对于保证手术成功至关重要.联合使用关节镜技术可同时处理关节内病变,关节内病变的清理和下肢力线的改善共同保证术后良好的疗效.术后骨关节炎的进展仍然在继续,但非常缓慢,中期疗效仍较满意.胫骨高位闭合外翻截骨是治疗单纯内侧膝关节骨关节炎的理想方法. Objective:To study the results of closing-wedge high tibial osteotomy and arthroscopy for the treatment of medial compartment osteoarthritis of the knee.Methods:From October 2005 to June 2007,25 pati entsmet with our inclusion criteria.All the patients with medial compartment knee osteoarthritis were treated with arthroscopy and closing-wedge high tibial osteotomy.There were 11 males and 14 females,with a mean age of 53 years old.The pre-operative HSS knee score was 67.6±2.8,FTA was (185.54±1.11)°,and aLPTA was(96.54±0.52)° in average.The patients were followed up and evaluated according to HSS knee score.The efficacy of the osteotomy was evaluated by FTA and aLPTA.Results:All surgeries were successful without serious complication.All the patients were followed up,and the duration ranged from 5 to 7 years.The HSS was 85.5±3.7 at the 1st year and 80.3±5.4 at the latest follow-up.There was significant difference between every two scores of before operation and the two after operation(t=-33.135,P=0.000;t=-13.215,P=0.000).The FTA was(173.65±0.92)° at the 1st year and(174.34±0.53)° at the latest follow-up.There was significant difference between every two angles of before operation and after operation(t=28.739,P=0.000;t=2.331,P=0.048).The aLPTA was (87.32±0.33)° at the 1st year and (87.67±2.82)° at the latest follow-up.There was significant difference between every two angles of before operation and after operation(t=37.264,P=0.000;t=2.469,P=0.039).Conclusion:Indication is important and good surgical technique is critical for good clinical outcome.A detailed plan before operation is essential for the operation.Arthroscopy is helpful for treating the intra-articular pathology.The osteoarthritis is still in progress but in a slow mode.The combined method of arthroscopy and closing-wedge high tibial osteotomy is a reliable way for medial compartment osteoarthritis of the knee.
出处 《中国骨伤》 CAS 2013年第9期748-752,共5页 China Journal of Orthopaedics and Traumatology
关键词 骨关节炎 截骨术 膝关节 关节镜 Osteoarthritis,knee Osteotomy Knee joint Arthroscopes
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参考文献7

  • 1Ranawat CS, Insall JN ,Shine J. Duo- condylar knee arthroplasty: hospital for special surgery design [J ]. Clin Orthop Relat Res, 1976, (120) :76-82.
  • 2胡月正,温宏,潘孝云,余华晨.术中下肢机械力线精确定位在胫骨高位截骨中的应用[J].中国骨伤,2012,28(9):751-754. 被引量:10
  • 3Hankemeier S, Mommsen P, Krettek C, et al. Accuracy of high tibial osteotomy:comparison between open-and closed-wedge technique[J]. Knee Surg Sports Traumatol Arthrose,2010,18 (10) : 1328- 1333.
  • 4Hoell S, Suttmoeller J, Stoll V, et al. The high tibial osteotomy, open versus closed wedge,a comparison of methods in 108 patients [J]. Arch Orthop Trauma Surg, 2005,125 (9) : 638-643.
  • 5Brouwer RW, Bierma-Zeinstra SMA, van Raaij TM, et al. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year ran- domised, controUed study [J ]. J Bone Joint Surg Br, 2006,88 (11 ) : 1454-1459.
  • 6Feeley BT, Gallo RA, Sherman S, et al. Management of osteoarthritis of the knee in the active patient[J]. J Am Acad Orthop Surg,2010, 18(7) :406-416.
  • 7Pascale W, Luraghi S, Perieo L, et al. Do microfraetures improve high tibial osteotomy outcome [ J ]. Orthopedics, 2011,34 ( 7 ) : e251-255.

二级参考文献12

  • 1Tang WM, Zhu YH, Chiu KY. Axial alignment of the lower extremity in Chinese adults [ J ]. J Bone Joint Surg Am, 2000,82 : 1603-1608.
  • 2Brinker MR,Lund PJ,Barrack RL. Demographic biases of scoring instruments for the result of total knee arthroplasty [J ]. J Bone Joint Surg Am, 1997,79 ( 6 ) : 858-865.
  • 3Berman AT, Bosacco SJ, Kirshner S, et al. Factors influencing long- term results in high tibial osteotomy[J ]. Clin Orthop, 1991, (272) : 192-198.
  • 4Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy[ J ]. Knee Surg Sports, 2006,14(2) : 149-152.
  • 5Billings A,Scott DF, Camargo MP, et al. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early mo- tion. Long-term follow-up[J]. J Bone Joint Surg Am,2000,82(1 ) : 70-79.
  • 6Flarmne CH, Rtihmann O, Schmolke S,et al. Long-term outcome fol- lowing high tibial osteotomy with tension bend principle [J]. Arch Orthop Trauma Surg, 2003,123 ( 1 ) : 12-16.
  • 7Coventry MB, Ilstrap DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases [J ]. J Bone Joint Surg Am, 1993,75 (2) : 196-201.
  • 8Koshino T,Yoshida T,Ara Y,et al. Fifteen to twenty-eight years" follow-up results of high tibial valgus osteotomy for osteoarthritic knee [J ]. Knee, 2004,11 (6) :439-444.
  • 9Majima T, Yasuda K, Katsuragi R, et al. Progression of joint arthrosis 10 to 15 years after high tibial osteotomy [J ]. Clin Orthop Relat Res, 2000,381 : 177-184.
  • 10Rudan JF, Simurda MA. High tibial osteotomy. A prospective clini- cal and roentgenographic review [J]. Clin Orthop Relat Res, 1990, 255:251-256.

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