股骨远端截骨联合关节镜手术在外翻膝中的临床应用

Clinical application of distal femoral osteotomy combined with arthroscopic surgery in the treatment of valgus knee

目的评价股骨远端截骨联合关节镜技术治疗外翻膝的安全性和有效性。方法回顾性分析2017年1月至2020年12月嘉兴市第一医院收治的24例(25膝)外翻膝骨关节炎患者的临床资料,均行股骨远端截骨联合关节镜手术,并用国产股骨远端内侧锁定接骨板固定。统计分析患者手术前后髋膝踝角(HKA)、股骨远端外侧角(LDFA)、膝关节活动度(ROM)和美国特种外科医院膝关节功能评分(HSS)的变化。结果24例(25膝)患者随访(15.6±2.3)个月。HKA由术前的(171.22±2.51)°增加到末次随访时的(179.24±1.86)°,LDFA由术前的(82.17±2.03)°增加到末次随访时的(88.57±1.53)°,差异均有统计学意义(均P<0.05)。HSS从术前的(60.27±6.04)分改善至末次随访时的(87.80±5.50)分,差异有统计学意义(P<0.05)。25膝中有1膝出现截骨角度丢失,无矫正不足或矫正过度,无感染和骨折不愈合发生。结论采用股骨远端截骨联合关节镜手术治疗外翻膝骨关节炎,方法安全可靠,截骨时保留外侧骨性铰链是维持截骨角度及骨折愈合的重要因素。

Objective To evaluate the safety and effectiveness of distal femoral osteotomy combined with arthroscopy in the treatment of valgus knee.Methods A retrospective analysis was conducted on 24 patients(25 knees)with valgus knee osteoarthritis admitted to the First Hospital of Jiaxing from January 2017 to December 2020 who underwent distal femoral osteotomy combined with arthroscopic surgery and were fixed with domestically produced distal femoral locking plates.The changes in hip knee ankle angle(HKA),distal lateral femoral angle(LDFA),knee joint range of motion(ROM),and knee joint function score(HSS)of the American Special Surgery Hospital before and after surgery were statistically analyzed.Resultsl A total of 24 patients(25 knees)were followed up for(15.6±2.3)months.HKA increased from(171.22±2.51)°before surgery to(179.24±1.86)°at the last follow-up;LDFA increased from(82.17±2.03)°before surgery to(88.57±1.53)°at the last follow-up;The differences were statistically significant(P<0.05).The HSS score improved from preoperative(60.27±6.04)to the last follow-up(87.80±5.50),with a statistically significant difference(all P<0.05).One out of 25 knees experienced loss of osteotomy angle,without insufficient or excessive correction,infection,and non union of fractures.Conclusions The use of distal femoral osteotomy combined with arthroscopic surgery for the treatment of valgus knee osteoarthritis is a safe and reliable method.Retaining the lateral bone hinge during osteotomy is an important factor in maintaining the osteotomy angle and fracture healing.