Taylor空间外固定架在膝内侧间室骨关节炎下肢力线调整中的临床应用

Clinical application of Taylor spatial frame in adjustment of lower extremity force line of knee medial compartmental osteoarthritis

目的探讨胫骨高位截骨术(high tibial osteotomy,HTO)后采用Taylor空间外固定架(Taylor spatial frame,TSF)治疗膝内侧室骨关节炎(medial compartmental osteoarthritis,MCOA)调整下肢力线的安全性和有效性。方法回顾分析2016年10月—2017年4月采用HTO治疗的30例MCOA患者临床资料,根据固定方法不同分为外固定组(TSF外固定,16例)和内固定组(钢板内固定,14例)。两组患者性别、年龄、侧别、病程、术前下肢力线胫骨股骨机械轴夹角(mechanical femur tibia angle,MFTA)评价等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量;采用MFTA评价末次随访时术侧下肢力线恢复情况;术前及术后2周、1个月、3个月采用美国特种外科医院(HSS)评分评价临床疗效。结果外固定组手术时间及术中出血量均显著少于内固定组(P<0.05)。两组患者均获随访,随访时间9~16个月,平均12个月。术后内固定组2例截骨延迟愈合,外固定组1例延迟愈合,经对症处理后均愈合;两组均无针道感染、截骨处不愈合、骨髓炎等并发症发生。末次随访时采用MFTA标准评价下肢力线恢复情况,外固定组均达优,内固定组优10例、良4例,两组比较差异有统计学意义(Z=–2.258,P=0.024)。两组患者术后各时间点HSS评分均较术前显著改善,术后随时间延长HSS评分亦逐渐改善,差异均有统计学意义(P<0.05)。除术后3个月外固定组HSS评分显著高于内固定组(t=2.425,P=0.022)外,其余各时间点两组HSS评分比较差异均无统计学意义(P>0.05)。结论TSF在HTO治疗MCOA患者并纠正下肢力线方面拥有独特优势,其手术时间短、出血量少、固定牢固、并发症少,在术后可精确调节下肢力线,是一种安全有效的固定方式。

Objective To explore the safety and effectiveness of Taylor spatial frame(TSF)in the treatment of medial compartmental osteoarthritis(MCOA)of the knee and the adjustment of the lower extremity force line at the same time.Methods The clinical data of 30 patients with MCOA who underwent high tibial osteotomy(HTO)between October 2016 and April 2017 were retrospectively analyzed.According to the different fixation methods,they were divided into external fixation group(TSF external fixation,16 cases)and internal fixation group(locking steel plate internal fixation,14 cases).There was no significant difference between the two groups in gender,age,side,disease duration,mechanical femur tibia angle(MFTA),and other general data(P>0.05).The operation time and intraoperative blood loss of the two groups were recorded and compared;MFTA was used to evaluate the recovery of the lower extremity force line at last follow-up;Hospital for Special Surgery(HSS)score was used to evaluate the clinical effecacy before operation and at 2 weeks,1 month,and 3 months after operation.Results The operation time and intraoperative blood loss of external fixation group were significantly less than those of internal fixation group(P<0.05).All patients were followed up 9-16 months,with an average of 12 months.There were 2 cases of delayed healing in the internal fixation group and 1 case of delayed healing in the external fixation group,and all healed after symptomatic treatment.All patients in the two groups had no complication such as needle infection,nonunion at osteotomy,osteomyelitis,and so on.At last follow-up,MFTA standard was used to evaluate the recovery of force line.The results of external fixation group were all excellent,while the results of internal fixation group were excellent in 10 cases and good in 4 cases.The difference between the two groups was significant(Z=–2.258,P=0.024).The HSS scores in the two groups were significantly improved at each time point after operation,and gradually improved with time after operation(P<0.05).The HSS score of the external fixation group was significantly higher than that of the internal fixation group(t=2.425,P=0.022)at 3 months after operation;and there was no significant difference between the two groups at other time points(P>0.05).Conclusion TSF has unique advantages in HTO treatment of MCOA patients and correction of lower extremity force line,such as shorter operation time,less bleeding,firm fixation,and less complications.It can accurately adjust the lower extremity force line after operation and has good effectiveness.It is an effective and safe fixation method.