不同撑开角度的胫骨高位截骨术植骨和未植骨的疗效比较

Comparison of the Therapeutic Effects of High Tibial Osteotomy of Different Bracing Angles with and Without Bone Graft

目的比较不同截骨撑开角度下植骨和未植骨开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)在膝关节功能和愈合方面的差别。方法回顾性分析2019年10月至2022年9月首都医科大学宣武医院行OWHTO治疗的41例膝骨关节炎患者,其中男13例,女28例;年龄43~76岁,平均(58.88±7.60)岁。定义截骨撑开角度>10°为大间隙,截骨撑开角度≤10°为小间隙。将患者分为3组,A组截骨撑开角度>10°,进行自体植骨;B组截骨撑开角度>10°,不进行植骨;C组截骨撑开角度≤10°,不进行植骨。比较三组术后骨愈合及膝关节功能方面的差异。结果患者术后随访12~24个月,平均(13.76±3.35)个月。术后3个月,三组患者的骨愈合程度差异无统计学意义(P>0.05),说明不同撑开角度并未影响早期骨愈合。术后6个月、12个月,A组的骨间隙向最内侧填充进展较B组、C组明显,差异有统计学意义(P<0.05);B组、C组骨间隙最内侧填充进展差异无统计学意义(P>0.05)。术后3个月、6个月、12个月,三组患者的膝关节功能差异无统计学意义(P>0.05)。结论植骨对患者OWHTO术后膝关节功能改善方面无显著影响,但进行自体植骨对患者骨间隙最内侧的愈合有帮助。

Objective To compare the functional outcomes and healing processes between open wedge high tibial osteotomy(OWHTO)with bone grafting and without bone grafting,while considering different osteotomy bracing angles.Methods A retrospective analysis was conducted on 41 patients diagnosed with knee osteoarthritis and treated with OWHTO in the Orthopaedics Department of Xuanwu Hospital of Capital Medical University between October 2019 and September 2022.The cohort comprised 13 males and 28 females,aged 43 to 76 years,with a mean age of(58.88±7.60)years.Osteotomies with an opening angle>10°were classified as large gap,while those≤10°were classified as small gap.The patients were categorized into three groups:Group A(opening angle>10°with autologous bone grafting),Group B(opening angle>10°without bone grafting),and Group C(opening angle≤10°without bone grafting).Comparisons were made among the three groups regarding bone healing and knee joint function post-surgery.Results The patients were followed up for 12 to 24 months,with a mean follow-up duration of(13.76±3.35)months.At 3 months postoperatively,there was no statistically significant difference in bone healing among the groups(P>0.05),suggesting that different opening angles did not impact early bone healing.However,at 6 and 12 months postoperatively,Group A showed significantly greater medial gap filling compared to Groups B and C(P<0.05).No statistically significant difference was observed in medial gap filling between Groups B and C(P>0.05).Functional differences among the groups at 3,6,and 12 months postoperatively were not statistically significant(P>0.05),indicating that neither the osteotomy opening angle nor bone grafting influenced early functional recovery.Conclusion Autogenous bone grafting did not significantly enhance knee function improvement after OWHTO,but it was beneficial for healing the innermost part of the bone gap.