胫骨平台下截骨关节清扫治疗退行性膝关节病

Degenerative Osteoarthritis of Knee Joint Treated by Osteotomy of Subtibiat Plateau and Joint Debridement

目的 :退行性膝关节病 ,为一累及大多数老年人而治疗棘手的疾患 ,保守治疗效果欠佳 ,故设计胫骨平台下截骨、关节清扫的外科手术方法 ,以取得较好的疗效。方法 :(1)从胫骨前内台 ,骨板线以下 ,做伸向前、外、后三个方向之薄层楔形截骨 ,继从平台关节面 ,在厚垫保护下向下锤击嵌合截骨线 ,从内上斜向外下交叉 2枚钢针固定。 (2 )切除髌股关节为主 ,以及上下骨关节边缘增生骨赘、清除关节游离体、变性并继将脱落软骨面 ,切除变性滑膜。 (3)就近取骨膜做缺失软骨面贴付或缝合移植。结果 :2 1例病人 ,经平均 6 .7年随访 ,优良率占 90 .6 % ,效果较满意 ,无加重影响功能的并发症。结论 :胫骨平台下眉状截骨、关节清扫、骨膜移植修复软骨面的方法 ,为一治疗退行性膝关节病可行的外科治疗手段 ;认为设计构思合理 ,利于加宽关节间隙、骨内减压、恢复关节光整面 。

Objective: Degenerative osteoarthritis of knee joint of many old men was very difficult to treat.Conservative treatment was less effective.Author advise that subtibial plateau osteotomy and joint debridement was effective in clinic.Methods:(1)From aterior medial of tibial of subplateau,in three sides:auterior,external and posterior tibia was ostcotomized in wedge shape under protecting of thick pad medial plate of articular surface was beaten for appositing osteotomy fissure.Two needles were fixed in form of cross position.(2)The osteophyma of knee,osteochondritis dissecans and changing property synovium were all excised and joint debrided.(3)The short of cartilage was pasted or transplanted through adjacent periosteum.Results:21 cases followed up with an average period of 6～7 years,excellent and good results were 90.6%.Conclusion:The way of subtibial plateau osteotomy,joint debridement,periosteum graft and cartilage mend were uscful operation for treatment of degenerative osteoarthritis of knee joint.Author thought that the way was useful to enlarging joint compartment,reducing intraosseous pressure,recovering joint smooth surface.