膝内翻骨关节炎合并前交叉韧带损伤的微创治疗

Minimally invasive treatment of anterior cruciate ligament injury combined with varus osteoarthritis of the knee

目的总结胫骨高位截骨植骨内固定＋关节镜下前交叉韧带重建术治疗膝内翻骨关节炎合并前交叉韧带损伤的效果。方法对14例膝内翻骨关节炎合并前交叉韧带（anterior cruciate ligament，ACL）损伤的患者行关节镜下清理，处理关节内病变。取自体股薄肌、半腱肌肌腱，经编织处理后以ACL瞄准器于胫骨结节旁内侧皮质f位于截骨线下方，距截骨线不小于1cm）钻骨道，常规方法重建ACL，股骨端以钮扣钛板固定，胫骨端以可吸收钉固定。同时于胫骨结节上缘截骨，指向近端胫腓关节上部，矢状面平行于关节面的后倾，外侧骨皮质不完全截断，行胫骨高位截骨，填充同种异体骨后以胫骨近端锁定解剖型钛板固定，矫正膝内翻。结果术后经6～28个月的随访，患者截骨端均于术后3个月内愈合，关节疼痛明显减轻，活动度满意，无关节不稳症状。HSS评分：术前（50．25±4．82）分，术后（80．12±3．41）分；Lysholm评分：术前（47．07±5．25）分，术后（78．08±2．52）分，差异有统计学意义（P〈0．05）。结论胫骨高位截骨植骨内固定＋关节镜下前交叉韧带重建术是有效治疗膝内翻骨关节炎合并前交叉韧带损伤的微创手术方法。

Objective To explore the outcomes of high tibia osteotomy with bone grafting and internal fixation ＋ arthroscopic reconstruction of anterior cruciate ligament （ ACL ） in the treatment of ACL injury combined with varus osteoarthritis of the knee. Methods 14 patients with varus osteoarthritis of the knee and ACL injury underwent arthroscopic debridement, with intra-articular lesions cleaned. Autologous gracilis muscle and semitendinosus muscle tendons were taken and underwent weaving treatment. After that, an ACL sighting device was used to create a bone tunnel in the medial cortex near the tibial tubercle （ under and no less than lcm from the osteotomy line ）. The ACL was reconstructed by the conventional method. The femoral fixation was performed with the button titanium plate and the tibial fixation with the absorbable screw. At the same time, osteotomy was performed on the upper edge of the tibial tubercle, pointing to the top of the proximal tibiofibular joint, and the sagittal plane was parallel to the articular surface. The lateral bone cortex was not completely cut off, and high tibia osteotomy was performed. When the allogeneic bone was filled in, the proximal tibial fixation was performed with the anatomical titanium locking plate and genu varum was corrected. Results All patients were followed up for 6-28 months. Healing of the osteotomy ends was achieved in patients within 3 months after the surgery, with significantly relieved joint pain, satisfactory range of movement （ ROM ） and no symptom of joint instability. The HSS scores were （ 50.25±4.82 ） points preoperatively and （ 80.12±3.41 ） points postoperatively; The Lysholm scores were （ 47.07±5.25 ） points preoperatively and （ 78.08±2.52 ） points postoperatively, and the differences were statistically significant （ P〈0.05 ）. Conclusions It is an effective and minimally invasive method of high tibia osteotomy with bone grafting and internal fixation ＋ arthroscopic reconstruction of ACL in the treatment of varus osteoarthritis of the knee combined with ACL injury.