锁定钢板固定的闭合楔形胫骨近端截骨术治疗膝内翻

Closed- wedge high tibial osteotomy with locking plate fixation for correction of varus knee

[目的]研究锁定钢板固定胫骨近端截骨术纠正膝内翻的有效性和安全性。[方法]本文为前瞻性研究,研究对象为膝内翻并伴有轻度膝关节内侧间室骨关节炎的年轻患者。作者在胫骨结节中下1/3处进行闭合楔形胫骨外侧外翻截骨,使用锁定钢板进行内固定。对术前术后的股胫角（FTA）、疼痛评分（VAS评分）和髌骨高度（InsallSalvati Index,IS指数）的改变进行评价。记录骨愈合情况和并发症的发生及处理。[结果]共有24例患者的35膝接受了胫骨近端闭合楔形外翻截骨术。患者平均年龄（28.4±6.9）岁（16~45）岁。平均随访（24.7±5.8）个月（15~33）个月。FTA矫正了（11.0±4.3）°（5~22）°。VAS评分明显改善。髌骨高度变化差异无统计学意义。所有截骨均愈合,有1例延迟愈合。本组无感染发生。2膝出现腓神经损伤症状。1例出现伸拇、伸趾和足背伸无力,半年后缓解;1例出现？母长伸肌无力,目前未恢复。[结论]锁定钢板固定的胫骨近端闭合楔形外翻截骨术治疗年轻患者的膝内翻安全有效。

[ Objective ] The aim of this study is to test the efficacy and safety of a modified closing wedge hightibial osteotomy （CWHTO） with LCP fixation for adults. [ Methods ] In this prospective study, A CWHTO was performed at the distal third of the tibial tuberosity. An locking compression plate （Tomofix LPT, Synthes） was used for internal fixation. Thirty -five knees in 24 young adults with tibia vara and mild medial arthritic changes were included. The average age was （28.4 ± 6. 9 ） （ 16 ± 45 ） years. [ Results] After a follow - up of （24. 7 ± 5.8） （ 15 ±33 ） months, the femoro - tibial angle （FleA） correction was （11.0-＋4.3） （5-22）°.Painwasrelievedfrom （2.5 ± 1.8） （1±7） to （0.6 ± 1.2） （0-3） inVASscore （P 〈 0. 001 ） . There was no significant change in patella height. Bone union was observed in all patients except for one delayed u- nion. A peroneal nerve lesion symptom was found in 2 knees. All adverse events were successfully treated except for a case of extensor hallucislongus muscle paralysis. [ Conclusion] The modified CWHTO with an LCP fixation is efficient and safe for the correction of tibia vara in young patients.