改良胫骨结节下单平面胫骨高位截骨术治疗膝骨关节炎的疗效

The effect of modified distal tibial tuberosity high tibial osteotomy in treatment of knee osteo-arthritis

目的 探讨改良胫骨结节下单平面胫骨高位截骨术(DTT-HTO)治疗膝骨关节炎的疗效。方法 采用DTT-HTO治疗54例膝骨关节炎患者。记录截骨处愈合情况、术后并发症发生情况,测量影像学相关指标,采用疼痛VAS评分和HSS评分评估疼痛缓解和膝关节功能恢复情况。结果 患者均获得随访,时间12~14(12.26±1.42)个月。术后6个月截骨间隙均正常愈合,无延迟愈合或不愈合情况发生。无下肢静脉血栓、接骨板激惹、外侧合页骨折、螺钉或接骨板断裂等并发症发生。HSS评分、疼痛VAS评分:术后6、12个月均明显优于术前(P<0.05)。髋膝踝角、胫骨近端内侧角、下肢负重力线百分比:术后各时间点均明显高于术前(P<0.05)。结论 采用DTT-HTO治疗膝骨关节炎,可精确矫正胫骨畸形,改善膝关节功能,缓解膝关节疼痛,且医师放射线曝露风险小。

Objective To investigate the clinical effect of modified distal tibial tuberosity high tibial osteotomy(DTTHTO) in the treatment of knee osteoarthritis(KOA).Methods The 54 patients with KOA were treated with DTTHTO. The healing situaiton of osteotomy site and the incidence of postoperative complications were recorded. The imaging related indexes were measured. The pain relief and functional recovery of knee joint were evaluated by pain VAS and HSS score.Results All patients were followed up for 12 ~ 14(12. 26 ± 1. 42) months. The osteotomy space healed normally at 6 months after operation,and no nonunion or delayed healing occured. There were no complications such as lower extremity venous thrombosis,bone plate irritation,lateral hinge fracture,screw or bone plate fracture.HSS score and pain VAS:at 6,12 months after operation,which were significantly better than those before operation(P< 0. 05). At each time point after operation,hip-knee-ankle angle,medial proximal tibial angle and the weightbearing force line percentage of lower limbs were significantly higher than those before operation(P< 0. 05).Conclusions The modified DTT-HTO is effective in the treatment of KOA. The operation can accurately correct the tibial deformity,improve the knee joint fuction,and relieve the pain of knee joint,and reduce the risk of the radiation exposure of medical staff.