以胫腓联合下为合页位置的内侧开放楔形高位胫骨截骨术的疗效

The Therapeutic Effects of Medial Open Wedge High Tibial Osteotomy with the Hinge Position Under the Tibiofibular Syndesmosis

目的探讨以胫腓联合下为合页位置的内侧开放楔形高位胫骨截骨术(MOWHTO)的疗效。方法以2016年9月至2018年10月于郑州大学第一附属医院骨科接受MOWHTO联合π形钛板内固定治疗的29例(43膝)膝关节内侧间室骨关节炎患者为研究对象。观察患者膝关节屈曲活动度、Lysholm膝关节功能评分量表(LKSS)评分、美国特种外科医院膝关节评分系统(HSS)评分、胫骨近端内侧角(MPTA)。结果所有患者均获得随访,随访时间为11~27个月,平均(19.74±4.86)个月。术后切口均一期愈合,1膝发生外侧合页骨折(LHF)。术后1 a,患者膝关节屈曲活动度、MPTA均较前增大,LKSS评分和HSS评分均较前增高(均P<0.05)。结论以胫腓联合下为合页位置的MOWHTO手术治疗膝关节内侧间室骨关节炎创伤小,近期效果满意,可有效减少术后LHF的发生。

Objective To explore the therapeutic effects of medial open wedge high tibial osteotomy with the hinge position under the tibiofibular syndesmosis.Methods Twenty-nine patients(43 knees) with osteoarthritis of medial compartment of knee were included in the study. The patients were all underwent MOWHTO combined with π-shaped titanium plate internal fixation in the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2018. The patients’ knee flexion activity, Lysholm knee score(LKSS), Hospital for Special Surgery(HSS) score, and medial-proximal-tibial angle(MPTA) were observed.Results All patients were followed up for 11 to 27 months, with an average of(19.74±4.86) months. All incisions were healed by first intention, and lateral hinge fracture(LHF) occurred in 1 knee. One year after the operation, the knee flexion activity and MPTA increased, and the LKSS score and HSS score were higher(all P<0.05).Conclusion For patients with osteoarthritis of medial compartment of knee, MOWHTO with the hinge position under the tibiofibular syndesmosis is less invasive and has a satisfactory short-term effect. It could help reduce the incidence of postoperative LHF.