胫骨高位开放楔形截骨术治疗膝关节前内侧骨关节炎的随访研究

The Application Follow-up Study of Open Wedge High Tibia Osteotomy for Knee Anterometer-Medial Osteoarthritis

目的:探讨双平面开放楔形胫骨高位截骨术(OWHTO)治疗膝关节前内侧骨关节炎(AMOA)的临床疗效和随访评价。方法:通过对膝关节骨关节炎的阶梯治疗策略分析,确定前内侧骨关节炎的开放楔形胫骨高位截骨术治疗方案,于2016年12月至2020年12月治疗48例前内侧骨关节炎患者并成功随访,其中男20例(20膝),女28例(28膝);年龄为48~65岁,平均为(57.1±3.4)岁。记录手术前、术后3个月、12个月、36个月的胫骨近端内侧角(MPTA)、膝关节活动度、疼痛视觉模拟量表(VAS)评分、膝关节Lysholm评分及美国特种外科医院(HSS)评分,并随访术后并发症情况。结果:48例患者在术后3个月、12个月及36个月进行了随访。术后胫骨近端内侧角较术前增大,患者的膝内翻畸形均得到矫正。术后3个月相比手术前、术后12个月相比术后3个月,VAS评分、Lysholm评分、HSS评分均明显增高,差异有统计学意义(P<0.05);术后36个月相比术后12个月,VAS评分、Lysholm评分、HSS评分差异无统计学意义(P>0.05)。患者无明显并发症发生,术后36个月未见明显骨关节炎的发生。结论:对于前内侧骨关节炎患者,开放楔形胫骨高位截骨术提供了一种安全有效的治疗方式,不但优化了传统胫骨高位截骨术,避免截骨处不愈合或延迟愈合,精确地纠正下肢力线。随着时间的推移,膝关节的症状和功能在术后1年内逐渐得到改善,1年左右达到平衡,随访3年未见明显关节炎的发生。

Objective:To investigate the clinical efficacy and follow-up evaluation of bi-plane open wedge high tibial osteotomy(OWHTO)on the treatment of knee anterometer-medial osteoarthritis(AMOA).Methods:The OWHTO treatment plan of AMOA was determined through the analysis of the ladder treatment strategy for knee osteoarthritis.48 patients with AMOA were treated and followed up successfully from December 2016 to December 2020,including 20 males(20 knees)and 28 females(28 knees).The average age was(57.1±3.4)years old(48 to 65 years old).The medial proximal tibia angle(MPTA),knee range of motion(ROM),visual analogue scale(VAS),Lysholm score and Hospital for Special Surgery(HSS)score were recorded before operation,3 months,12 months and 36 months after operation.Results:48 patients were followed up successfully at 3,12 and 36 months after operation.The postoperative MPTA was larger than that before operation,and the genu varus deformity was effectively corrected.VAS score,Lysholm score and HSS score were significantly higher at 3 months after operation than before operation and 12 months after operation(P<0.05),and these items 36 months after operation was significantly higher than these 12 months after operation.There was no significant difference in VAS score,Lysholm score and HSS score(P>0.05).There were no obvious complications and no obvious osteoarthritis was observed 36 months after operation.Conclusion:OWHTO provides a safe and effective treatment for patients with AMOA.It not only optimizes traditional high tibial osteotomy,avoids nonunion or delayed union at the osteotomy site,and accurately corrects the lower limb alignment.With the passage of time,the symptoms and function of the knee joint gradually improved within 1 year after operation,and reached a balance about 1 year after operation.No obvious arthritis was observed during 3 years of follow-up.