开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察

Effectiveness of open wedge high tibial osteotomy on medial unicompartmental knee osteoarthritis

目的探讨开放楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)治疗膝关节内侧间室骨关节炎的效果。方法回顾分析2015年1月—2017年1月采用OWHTO治疗的61例膝关节内侧间室骨关节炎患者临床资料。男14例,女47例;年龄44~60岁,平均52.8岁。体质量指数为19.1~34.7 kg/m2,平均25.3 kg/m2。左膝27例、右膝34例。病程1~9年,平均5.3年。骨关节炎分期:Ⅱ期33例,Ⅲ期28例。术前膝关节美国特种外科医院(HSS)评分为(56.0±3.7)分,行走时膝关节疼痛视觉模拟评分(VAS)为(4.6±1.0)分。结果手术时间为49~85 min,平均66.5 min;切口长度为10~13 cm,平均11.0 cm;总显性失血量为80~210 m L,平均139.1 m L;术后卧床时间为1~10 d,平均4.7 d。患者均获随访,随访时间12~24个月,平均17.3个月。术后3个月X线片测量示胫骨平台负重区为60.3%~66.8%,平均63.4%。术后3、6个月,膝关节HSS评分分别为(79.1±4.2)、(85.3±3.1)分,VAS评分分别为(1.7±0.7)、(0.6±0.5)分,差异均有统计学意义(P<0.05)。结论 OWHTO治疗膝关节内侧间室骨关节炎疗效确切,力线纠正理想,并发症较少,但应注意术前需要精确测量术中张开角。

Objective To evaluate the effectiveness of open wedge high tibial osteotomy（OWHTO） in treatment of medial unicompartmental knee osteoarthritis（MUKOA）. Methods A clinical data of 61 cases with MUKOA who were treated with OWHTO between January 2015 and January 2017 were retrospectively analyzed. There are 14 males and47 females with an average age of 52.8 years（mean, 44-60 years）. The body mass index ranged from 19.1 to 34.7 kg/m^2（mean, 25.3 kg/m^2）. Twenty-seven cases were left side and 34 cases were right side. The disease duration was 1-9 years（mean, 5.3 years）. The MUKOA was rated as stage Ⅱ in 33 cases and stage Ⅲ in 28 cases. Preoperative Hospital for Special Surgery（HSS） score was 56.0±3.7. Walking visual analogue scale（VAS） score was 4.6±1.0. Results The operation time was 49-85 minutes（mean, 66.5 minutes）. The length of incision was 10-13 cm（mean, 11.0 cm）. The total overt blood loss was 80-210 m L（mean, 139.1 m L）. The postoperative bed-rest time was 1-10 days（mean, 4.7 days）. All patients were followed up 12-24 months（mean, 17.3 months）. The bearing area of tibial platform at 3 months after operation was 60.3%-66.8%, with an average of 63.4%. At 3 and 6 months after operation, the HSS score was 79.1±4.2 and 85.3±3.1 respectively, and the VAS score was 1.7±0.7 and 0.6±0.5 respectively, all showing significant differences（P0.05）. Conclusion OWHTO is an ideal choice for treating MUKOA with less postoperative complications. The force line could be corrected by OWHTO. However, the preoperative preparations are very important, especially that the open angle should be measured accurately.