股骨髁上截骨治疗膝外翻骨关节炎的疗效观察

Effectiveness of Femoral Supracondylar Osteotomy For the Treatment of Valgus Knee with Osteoarthritis

目的探讨股骨髁上内侧闭合性楔形截骨结合Tomofix锁定钢板固定治疗膝外翻畸形骨关节炎的临床疗效。方法回顾性分析2016年1至2017年12月期间西南医科大学附属医院骨关节外科收治的伴外翻畸形的膝关节骨关节炎患者24例,采取股骨髁上内侧闭合性楔形截骨结合Tomofix锁定钢板固定的手术方式进行治疗。其中男9例(9膝),女15例(15膝);年龄30~58岁,平均43.6岁。病程1~8年,平均5.6年。骨关节炎按照KellgrenLawrenee分级标准:Ⅰ级13膝,Ⅱ级9膝,Ⅲ级2膝。手术前后拍摄双下肢负重位全长X线片和患侧膝关节负重正侧位X线片,比较手术前后股骨远端外侧角、胫股角的变化。术后通过随访观察骨愈合情况、手术并发症,比较治疗前后膝关节炎进展情况、Lysholm评分、美国特种外科医院(the hospital special surgery,HSS)评分、国际膝关节文献委员会(international knee documentation committee,IKDC)评分等,综合评价该术式治疗膝外翻畸形骨关节炎的效果。结果患者术后切口均Ⅰ期愈合,未发现感染、下肢深静脉血栓形成、骨不愈合或延迟愈合等并发症发生。24例患者均获随访,随访时间9~22个月,平均14.8个月。末次随访时所有患者术后膝关节外翻畸形得到矫正,患者的股骨远端外侧角由术前(78.36±2.78)°矫正至(84.72±3.64)°(P<0.05),胫股角由术前(170.41±3.86)°矫正至(181.45±2.78)°(P<0.05);Lysholm评分、HSS评分、IKDC评分均较术前明显提高,差异有统计学意义(P<0.05)。结论股骨髁上内侧闭合性楔形截骨结合Tomofix锁定钢板固定的手术技术治疗膝外翻畸形骨关节炎,操作简便,可有效矫正膝关节外翻畸形,短期疗效满意,但中远期疗效有待进一步观察。

Objective To evaluate the clinical efficacy of medial close supracondylar osteotomy of the femoral condyle with Tomofix locking compression palte for the treatment of valgus knee osteoarthritis.Methods A retrospective study was performed on 24 patients with valgus knee and osteoarthritis who underwent medial close supracondylar osteotomyof the femoral condyle combined with Tomofixlocking compression paltefixation in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 9 males（9 knees）and 15 females（15 knees）,aged 30~58 years（mean,43.6 years）.The disease duration was 1 to 8 years（mean,5.6 years）.According to Kellgren-Lawrenee grading standard,13 knees were classified as stage I,9 knees as stageⅡ,and 2 knees as stageⅢ.The full-length AP view of the lower extremity and the weight bearing AP and lateral view of the knee were obtained before and after operation,and the lateral distal femoral angle,femoral-tibial angle were evaluated.Clinical outcomes were comprehensively assessed according to the bone healing time,postoperative complications,progress of knee osteoarthritis after operation,theLysholm score,Hospital for Special Surgery（HSS）score,and International Knee Documentation Committee（IKDC）score before and after operation.Results All the wounds healed primarily,and no complication of infection,deep vein thrombosis,nonunion or delayed union was observed.All patients were followed up 9~22 months（mean,14.8 months）.At last follow-up,the valgus deformity of knee joint was corrected in all patients after operation.The lateral distal femoral angles was improved from the preoperative（78.36±2.78）°to the final follow up time（84.72±3.64）°（P〈0.05）.Tibiofemoral angle was improved from the preoperative（170.41±3.86）°to the final follow up time（181.45±2.78）°（P〈0.05）.Lysholmscore,Hospital of Special Surgery（HSS）score,and International Knee Documentation Committee（IKDC）score were significantly higher than preoperative ones（P〈0.05）.Conclusion The medial close supracondylar osteotomy combined with Tomofix locking compression palte fixation is a convient method for the treatment of valgus knee osteoarthritis and can effectively correct the valgus deformity.The short-term clinical efficacy is satisfactory,but long-term efficacy remains to be investigated.