胫骨内侧开放高位截骨术中植骨与未植骨的疗效分析

Analysis of the effect of bone grafting and no bone grafting in open high tibial medial osteotomy

目的 探究胫骨内侧开放高位截骨术中是否需要植骨填充截骨端缺损。方法 回顾性分析安徽医科大学第二附属医院于2019年6月至2022年3月行胫骨内侧开放高位截骨术且符合纳入排除标准的患者98例,其中植骨组50例(取自体髂骨植骨9例,异体骨植骨41例),未植骨组48例。比较两组的愈合程度、矫正角度、撑开高度、术后负重时间及各类并发症发生情况;术前及术后1、3、6、12个月的HKA、MPTA、HSS评分、VAS评分、WOMAC膝关节炎指数、膝伸-屈ROM。结果 98例患者均随访12~33个月,平均(20.2±7.3)个月。两组患者在矫正角度、撑开高度、HKA、MPTA方面比较,差异无统计学意义(P>0.05),末次随访愈合程度差异也无统计学意义(P>0.05),术后植骨组患者负重时间早于未植骨组(P<0.05)。两组均未发生明显并发症(未植骨组伤口延迟愈合1例)。与术前相比,术后两组患者HSS评分、VAS评分、WOMAC膝关节炎指数、ROM有显著改善(P<0.05),相同时间组间比较差异无统计学意义(P>0.05)。结论 在适应证允许的情况下,胫骨内侧开放高位截骨术中未发现不植骨对临床效果有特殊影响。

Objective To investigate whether bone graft is needed to fill the defect of the osteotomy end in high tibial osteotomy(HTO).Methods A retrospective analysis was performed on 98 patients who underwent HTO in the Second Affiliated Hospital of Anhui Medical University from June 2019 to March 2022 and met the exclusion criteria,including 50 patients in the bone graft group(9 patients with iliac bone graft,41 patients with allogeneic bone graft),and 48 patients in the non-bone graft group.The healing degree,correction angle,distraction height,postoperative weight-bearing time and various complications were compared between the two groups.Preoperative and postoperative HKA,MPTA,HSS,VAS,WOMAC knee arthritis index,knee extension-flexion ROM at 1,3,6 and 12 months were compared.Results All 98 patients were included in the study and were followed up for 12 to 33 months,with an average follow-up time of(20.2±7.3)months.There were no significant differences in the correction angle,elongation height,HKA and MPTA between the two groups(P>0.05),and there were no significant differences in the healing degree at the last follow-up(P>0.05).The weight-bearing time of the bone graft group was earlier than that of the non-bone graft group(P<0.05).There were no obvious complications in both groups(one case of delayed wound healing in non-bone graft group).Compared with preoperative,HSS score,VAS score,WOMAC knee arthritis index and ROM in the two groups were significantly improved after operation(P<0.05),but there was no difference between the two groups at the same time(P>0.05).Conclusion No bone grafting during HTO has no effect on the clinical effect under indication.