前外侧合页的胫骨内侧高位截骨在减小胫骨平台后倾角中的作用

Role of anterolateral hinge medical high tibial osteotomy in reducing tibial platesu posterior inclination

目的探究前外侧合页的胫骨内侧高位截骨术(HTO)对胫骨后倾角(PTS)及髌骨高度的影响,为膝内翻合并较大胫骨后倾角和(或)低位髌骨患者提供理想手术方式。方法选取2016年3月—2019年6月在解放军总医院第三医学中心骨一科行前外侧合页胫骨高位截骨术的26例患者(42膝),其中,17例(25膝)为合并前交叉韧带损伤的武警战士,9例(17膝)为膝骨关节炎的地方患者,所有患者胫骨后倾角均≥11.5°。将所有患者术前和术后末次随访行Lysholm评分、膝关节协会评分(KSS)、视觉模拟评分(VAS),评估患者功能改善及膝关节疼痛情况。测量患者术前及术后PTS和髌骨高度比值(CDI),采用单因素方差分析研究术前术后各组间的PTS、CDI的差值是否具有统计学意义。结果随访时间12.6~26.8个月,平均随访(19±6.5)个月。所有病例术前Lysholm评分平均值为(87.3±5.3)分,末次随访提高至(97.1±3.1)分;KSS评分平均为(62.7±7.5)分,末次随访提高至(85.1±8.1)分;术前VAS平均为(4.3±2.3)分,末次随访降至(1.4±1.1)分;术前及术后比较,差异均有统计学意义(P<0.05)。术后PTS平均角度由术前(18.2±6.7)减小至(9.3±4.6),差异有统计学意义(P<0.05)。髌骨高度比值CDI从术前的(1.13±0.19)减小为术后的(1.08±0.21),差异无统计学意义(P>0.05)。结论前外侧合页的HTO既能矫正膝内翻患者的下肢力线,同时又能避免增大后倾角和降低髌骨高度,是对常规胫骨高位楔形截骨术的补充,可作为膝内翻合并较大PTS和(或)低位髌骨患者的首选方案。

Objective To investigate the effect of anterolateral hinge medial high tibial osteotomy on tibial posterior slope(PTS)and patellar height,and to provide an ideal surgical method for patients with genu varus combined with large tibial posterior slope and/or low patella.Methods 26 patients(42 knees)who underwent anterolateral hinge tibi⁃al high osteotomy in the first Department of orthopedics of our hospital from March 2016 to June 2019 were selected,of which 17 cases(25 knees)were armed police soldiers with anterior cruciate ligament injury and 9 cases(17 knees)were local patients with knee osteoarthritis.The tibial retroversion angle of all patients was≥11.5°.Lysholm score,keen Society score(KSS)and visual analogue scale(VAS)were performed in all patients before and after the last fol⁃low-up to evaluate the improvement of function and knee pain.The ratio of PTS to patellar height(CDI)was measured before and after operation.The difference of PTS and CDI between preoperative and postoperative groups was studied by one-way ANOVA.Results The mean follow-up time was 26.6 months to 26.5 months.The mean preoperative Lysholm score of all cases was(87.3±5.3),and the last follow-up was(97.1±3.1);The average KSS score was(62.7±7.5)and increased to(85.1±8.1)at the last follow-up;The average VAS score was(4.3±2.3)before operation and decreased to(1.4±1.1)at the last follow-up;There were significant differences before and after operation(P<0.05).The average angle of PTS decreased from(18.2±6.7)to(9.3±4.6)after operation;There were significant differences before and after operation(P<0.05).The ratio of patellar height to CDI decreased from(1.13±0.19)to(1.08±0.21)(P>0.05).Conclusion Anterolateral hinge HTO can not only correct the lower limb force line of patients with genu varus,but also avoid in⁃creasing caster angle and reducing patellar height.It is a supplement to conventional OWHTO.It can be used as the first choice for patients with genu varus complicated with large PTS and/or low patella.