胫骨近端截骨联合异体股骨头植骨治疗膝骨关节炎

Proximal tibial open-wedge osteotomy combined with allografting of femoral head for knee medial compartment osteoarthritis

[目的]介绍胫骨近端开放楔形截骨联合同种异体股骨头植骨治疗膝骨性关节炎的手术技术与临床疗效。[方法] 2014年6月~2016年4月对20例膝内翻合并内侧间室骨关节炎患者进行胫骨近端开放楔形截骨联合同种异体股骨头植骨治疗。采用Miniaci法进行冠状平面矫正的术前设计,行胫骨近端内侧弧形切口,打入3枚导针,透视确定骨圆针位置满意后,采用摆锯和截骨骨凿,至距离胫骨外侧皮质1cm处,逐步撑开内侧胫骨截骨处,至力线杆应通过胫骨髁间棘外侧1/3的位置。按截骨间隙张开程度截取同种异体股骨头骨块,植入胫骨内侧截骨间隙,采用胫骨近端加压锁定钢板内固定。[结果] 20例患者均顺利手术,无严重并发症。术后平均随访(14.62±5.84)个月。VAS评分从术前的(2.48±1.82)分降至末次随访时的(0.63±1.21)分,差异有统计学意义(P<0.05)。术后所有患者截骨处均达到骨性愈合。胫股角由术前(192.58±3.77)°显著矫正至末次随访时(173.62±2.43)°(P<0.05),平均矫正度(10.02±4.29)°。[结论]应用胫骨近端开放楔形截骨结合同种异体股骨头植骨治疗膝内翻合并单间室骨关节炎可获得良好的临床效果。

[Objective]To introduce the surgical technique and clinical outcomes of proximal tibial open-wedge osteotomy combined with allografting of femoral head for knee medial compartment osteoarthritis.[Methods]From June 2014 to April2016,20 patients underwent proximal tibial open-wedge osteotomy combined with allografting of femoral head for knee medial compartment osteoarthritis in our department.The preoperative design was formulated by Miniaci method in coronal plane correction.A curved longitudinal incision was made on medial proximal tibia,and 3 guide pins were placed.After confirming proper position of the guider pins inserted by fluoroscopy,osteotomy of the proximal tibia was conducted with oscillating saw to 1 cm near the lateral tibial cortical bone.The osteotomy gap was gradually distracted to open medially till the alignment rod passed through the lateral third of the tibial intercondylar eminence on fluoroscopy.A bone block cut from allogenic femoral head was trimmed according to opening of the osteotomy gap,and then inserted into the gap.Finally,the proximal tibia was internally fixed with a locking plate.[Results]All the patients had surgical procedures performed smoothly without intraoperative complications.The follow-up period lasted for(14.62±5.84)months.The VAS score significantly improved from(2.48±1.82)preoperatively to(0.63±1.21)at the latest follow up,which was statistically significant(P<0.05).In term of radiographic assessment,all the osteotomy achieved bony healing,and the tibiofemoral angle was significantly corrected from(192.58±3.77)°preoperatively to(173.62±2.43)°at the latest follow up(P<0.05),with an average correction of(10.02±4.29)°.[Conclusion]This proximal tibial open-wedge osteotomy combined with allografting of femoral head achieves satisfactory clinical outcomes for mere knee medial compartment osteoarthritis accompanied with varus deformity.