原位推进骨瓣技术与不植骨在开放楔形胫骨高位截骨术中对截骨间隙愈合的影响比较

Effects of advanced bone flap versus no bone flap on the healing of osteotomy gap in high tibial osteotomy

目的比较原位推进骨瓣技术与不植骨在开放楔形胫骨高位截骨术(OW-HTO)中对截骨间隙愈合效果的影响。方法回顾性分析2021年3-12月于河北医科大学第三医院创伤急救中心行OW-HTO的85例内侧间室骨关节炎伴膝内翻患者的临床资料。根据是否植骨将患者分为2组:推进骨瓣组(术中采用原位推进骨瓣技术)42例,女32例,男10例;年龄(63.7±6.6)岁。未植骨组(术中不植骨)43例,女31例,男12例;年龄(63.2±9.4)岁。记录并比较的两组患者指标包括:术后3、6、12、18个月截骨间隙愈合率,术后6、18个月西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、疼痛视觉模拟评分(VAS)、膝关节损伤和骨关节炎评分(KOOS),术后即刻、术后18个月胫骨近端内侧角(MPTA)、股胫角,以及术后并发症发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后3、6、12、18个月推进骨瓣组患者的截骨间隙愈合率均显著高于未植骨组,差异均有统计学意义(P<0.05)。术后6个月推进骨瓣组患者的WOMAC[(26.1±5.9)分]、疼痛VAS[(4.1±1.4)分]、KOOS[(47.0±9.7)分]均显著低于未植骨组[(31.3±8.3)、(4.8±1.6)、(56.1±11.9)分],差异均有统计学意义(P<0.05),但术后18个月两组患者的以上指标比较差异均无统计学意义(P>0.05)。术后即刻两组患者的MPTA、股胫角比较差异均无统计学意义(P>0.05)。术后18个月推进骨瓣组MPTA(88.7°±1.1°)优于未植骨组(87.7°±1.5°),差异有统计学意义(P<0.05)。未植骨组总并发症发生率为27.9%(12/43),显著高于推进骨瓣组的2.4%(1/42),差异有统计学意义(P<0.05)。结论在OW-HTO治疗内侧间室骨关节炎伴膝内翻患者中,采用原位推进骨瓣技术填充截骨间隙可加速截骨间隙愈合,减少截骨间隙延迟愈合或不愈合的情况发生。

To compare the effects of advanced bone flap and no bone flap on the healing of osteotomy gap in open-wedge high tibial osteotomy(OW-HTO)for the treatment of medial compartment osteoarthritis and knee inversion.Methods A retrospective study was conducted to analyze the 85 patients who had undergone OW-HTO from March 2021 to December 2021 at Trauma Emergency Centre,The Third Hospital of Hebei Medical University for medial compartment osteoarthritis and knee inversion.The patients were divided into 2 groups according to whether bone flap was grafted.In group A of 42 patients who received advanced bone flap intraoperatively,there were 32 females and 10 males with an age of(63.7±6.6)years;in group B of 43 patients who received no advanced bone flap intraoperatively,there were 31 females and 12 males with an age of(63.2±9.4)years.The measures recorded and compared between the 2 groups included:osteotomy gap healing rates at 3,6,12,and 18 months postoperatively;Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Visual Analog Scale(VAS)for pain,and Knee injury and Osteoarthritis Outcome Score(KOOS)at 6 and 18 months postoperatively;medial proximal tibial angle(MPTA)and femorotibial angle at immediate postoperation and 18 months postoperation;postoperative complications.Results The differences in preoperative general information between the 2 groups were not statistically significant,showing comparability(P>0.05).The osteotomy gap healing rates at 3,6,12,and 18 months postoperatively in group A were significantly higher than those in group B(P<0.05).The WOMAC(26.1±5.9),VAS(4.1±1.4),and KOOS(47.0±9.7)scores at 6 months postoperatively in group A were significantly lower than those in group B(31.3±8.3,4.8±1.6,and 56.1±11.9)(P<0.05),but the differences in the above indicators between the 2 groups at 18 months postoperatively were not statistically significant(P>0.05).There was no statistically significant difference in MPTA or femorotibial angle at immediate postoperation between the 2 groups(P>0.05).At 18 months postoperatively,the MPTA in group A(88.7°±1.1°)was significantly better than that in group B(87.7°±1.5°)(P<0.05).The total complication rate in group B[27.9%(12/43)]was signifcantly higher than that in group A[2.4%(1/42)](P<0.05).Conclusions In the OW-HTO treatment of the patients with medial compartment osteoarthritis and knee inversion,application of an advanced bone flap to fill the osteotomy gap can accelerate the gap healing and reduces occurrence of delayed healing or non-healing of the osteotomy gap.