推进骨瓣技术在胫骨高位截骨术治疗膝关节骨性关节炎中的初步研究

Preliminary study of advanced bone flap technique in high tibial osteotomy for the treatment of knee osteoarthritis(KOA)

膝关节骨性关节炎(KOA)是一种常见的退行性病变,多见于中老年人,随着老龄化的加剧,其发病率逐渐升高,且有低龄化发展的趋势。其中,大多数患者为单纯内侧间室型KOA。胫骨高位截骨术(HTO)是治疗内侧间室型KOA的一种有效方式,可推迟或避免全膝关节置换术的发生。内侧撑开式截骨术,具有创伤小、不破坏胫腓关节、降低腓总神经损伤、术中灵活调整截骨角度等优点,是当下进行HTO的主要选择方式。然而,其显著缺点之一在于,截骨间隙较大,缺乏有效填充,相关的骨延迟愈合或不愈合屡见不鲜,困扰着广大骨科医生。通过总结临床经验,本团队率先提出应用腓骨移植和推进骨瓣技术,在胫骨高位截骨、接骨板支撑固定后有效填充截骨间隙,以达到快速建立骨连接、促进骨愈合的目的。

Knee osteoarthritis(KOA)is a common degenerative disease,most common in middle aged and elderly people.With the aggravation of aging,the incidence of KOA is gradually increasing.As well,the onset age is getting younger.Medial osteoarthritis was the common one of the KOA.High tibial osteotomy(HTO)is a widely used treatment option for medial osteoarthritis,especially in young patients with early osteoarthritis,which can delay or avoid the occurrence of total knee arthroplasty.Medial opening wedge high tibial osteotomy(MOWHTO)has the advantages of less trauma,no damage to the tibiofibular joint,lower damage to the common peroneal nerve,and flexible adjustment of angle during the operation.However,significant disadvantages are puzzling most of orthopedic surgeons,such as the large osteotomy space,lack of effective filling,with a high rate delayed or nonunion,et al.Therefore,we proposed the application of fibula transplantation and advanced bone flap technology to effectively fill the osteotomy space,so as to achieve the purpose of rapidly establishing bone connection and promoting bone healing.