胫骨内侧开放楔形高位截骨治疗膝关节内侧间室骨关节炎的短期疗效

doi:10.6040/j.issn.1671-7554.0.2016.534

摘要/Abstract

摘要： 目的探讨胫骨高位截骨(HTO)治疗膝关节内侧间室骨关节炎的短期疗效。方法选取2015年1月至2016年1月行胫骨高位截骨患者20例(共26膝)。采用美国膝关节协会评分(AKS)、美国西大略湖和麦克马斯特大学骨关节炎指数评分(WOMAC)及视觉模拟评分(VAS),测量胫骨近端内侧角(MPTA)和股胫角(FTA)等术前、术后指标对HTO治疗膝关节内侧间室骨性关节炎的疗效进行评估与分析。结果 20例患者均获得随访,随访时间3~12个月,患者术后膝关节疼痛、下肢力线均明显改善。1例刀口浅表感染,其他恢复良好、无并发症。患者术后AKS评分、WOMAC评分、VAS评分、MPTA和FTA角度与术前相比,差异有统计学意义(P<0.05)。结论 HTO纠正了下肢异常力线的分布,消除或缓解膝关节疼痛,延缓膝关节退行性病变的进展,短期获得较好的临床效果,中远期疗效有待进一步随访跟踪和研究。

关键词: 开放楔形, 胫骨高位截骨术, 截骨, 内侧关节炎, 膝关节

Abstract: Objective To observe the short-term curative effect of high tibia osteotomy(HTO)in the treatment of knee medial compartment osteoarthritis. Methods A total of 20 patients(26 knees)treated during Jan. 2015 and Jan. 2016 were involved. The curative effect was evaluated using American knee society(AKS), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), visual analogue scale(VAS), medial proximal tibial angle(MPTA), and femorotibial angle(FTA). Results During the follow-up of 3-12 months, both knee joint pain and lower limb strength were significantly improved. Superficial infection occurred in 1 case and no other complications were observed. The postoperative AKS score, WOMAC score, VAS score, MPTA and FTA were significantly improved(P<0.05). Conclusion HTO can correct the abnormal force distribution of lower extremities, relieve or eliminate knee pain, and delay the progress of the knee joint degeneration, thus showing good short-term curative effect. The long-term efficacy needs to be further observed.

Key words: High tibial osteotomy, Knee, Osteotomy, Open wedge, Medial joint arthritis

中图分类号:

R687.3

包学智,赵蓬,刘培来,卢群山,李明,张元凯,李德强. 胫骨内侧开放楔形高位截骨治疗膝关节内侧间室骨关节炎的短期疗效[J]. 山东大学学报（医学版）, 2016, 54(10): 85-89.

BAO Xuezhi, ZHAO Peng, LIU Peilai, LU Qunshan, LI Ming, ZHANG Yuankai, LI Deqiang. Short-term curative effect of open wedge high tibial osteotomy in the treatment of medial compartment knee osteoarthritis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(10): 85-89.

参考文献

[1] Haviv B, Bronak S, Thein R, et al. Mid-term outcome of opening-wedge high tibial osteotomy for varus arthritic knees[J]. Orthopedics, 2012, 35(2): 192-196.
[2] 熊福军, 贺西京, 冯宏伟, 等. 关节镜下胫骨高位截骨治疗早期膝骨关节炎并内翻畸形疗效观察[J]. 现代中西医结合杂志, 2014, 23(4): 389-390.
[3] 袁荣霞, 胡勇, 李强, 等. 关节镜下清理结合胫骨高位截骨术治疗膝内侧骨关节炎[J]. 四川医学, 2009, 30(3): 342-343. YUAN Rongxia, HU Yong, LI Qiang, et al. Arthroscopic debridement combined with high tibial osteotomy for osteoarthritis in the medial space of knee joints[J]. Sichuan Medical Journal, 2009, 30(3): 342-343.
[4] Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee[J]. J Bone Joint Surg Br, 1961, 43-B(12): 746-751.
[5] Prodromos CC, Amendola A, Jakob RP. High tibial osteotomy: indications, techniques, and postoperative management[J]. Instr Course Lect, 2015, 64(10): 555-565.
[6] 宋德臣, 李瑞, 张有磊. 胫骨高位截骨术治疗伴膝内翻的膝关节骨性关节炎[J]. 中国矫形外科杂志, 2013, 21(9): 897-899.
[7] S. Terry Canale James H. Bety. 坎贝尔骨科手术学——关节外科[M]. 12版. 王岩, 陈继营, 周勇刚,等译.北京: 人民军医出版社, 2015: 436-446.
[8] 徐亚风, 罗从风, 张长青, 等. 内侧张开胫骨高位截骨术中未植骨的预后研究[J]. 国际骨科学杂志, 2015, 36(2): 146-150. XU Yafeng, LUO Congfeng, ZHANG Changqing, et al. The clinical study of edial opening-wedge high tibial osteotomy without bone graft[J]. Orthop, 2015, 36(2): 146-150.
[9] Brinkman JM, Lobenhoffer P, Agneskirchner JD, et al. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies[J]. J Bone Joint Surg Br, 2008, 90(12): 1548-1557.
[10] 黄野, 杜辉, 顾建明, 等. 锁定钢板固定闭合楔形胫骨近端截骨术治疗膝内翻(24例35膝报告)[J]. 中国矫形外科杂志, 2014, 22(11): 985-989. HUANG Ye, DU Hui, GU Jianming, et al. Closed-wedge high tibial osteotomy with locking plate fixation for correction of varus knee[J]. Orthopedic Journal of China, 2014, 22(11): 985-989.
[11] Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints[J]. Orthop Clin North Am, 1979, 10(3): 585-608.
[12] Niinimaki TT, Eskelinen A, Ohtonen P, et al. Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: a 22-year population-based study[J]. Int Orthop, 2012, 36(7): 1399-1402.
[13] 李瑞, 宋德臣, 张有磊, 等. 胫骨高位截骨治疗膝关节骨关节炎并膝内翻[J]. 实用骨科杂志, 2013, 19(12): 1081-1084. LI Rui, SING Dechen, ZHANG Youlei, et al. High tibial osteotomy and fixation with tibial plate for osteoarthritis of the knee associated with varus[J]. Journal of Practical Orthopaedics, 2013, 19(12): 1081-1084.
[14] Lee DC, Byun SJ. High tibial osteotomy[J]. Knee Surg Relat Res, 2012, 24(2): 61-69.
[15] 董跃福, 蒋胜波, 刘旭东. 胫骨高位截骨术治疗内翻型膝关节骨性关节炎[J]. 现代医药卫生, 2013, 29(23): 3565-3566. DONG Yuefu, JIANG Shengbo, LIU Xudong. High tibial osteotomy for the treatment of varus knee osteoarthritis[J]. Mod Med Health, 2013, 29(23): 3565-3566.
[16] Coventry MB. Upper tibial osteotomy for osteoarthritis[J]. J Bone Joint Surg Am, 1985, 67(7): 1136-1140.
[17] 郑艮强, 吴斗, 赵恩哲, 等. 膝关节周围截骨术对膝关节骨关节炎伴内翻畸形的治疗策略[J]. 中华老年骨科与康复电子杂志, 2016, 2(1): 44-49.
[18] Preston CF, Fulkerson EW, Meislin R, et al. Osteotomy about the knee: applications, techniques, and results[J]. J Knee Surg, 2005, 18(4): 258-272.
[19] 于风天, 魏杰, 秦德安. 胫骨高位截骨治疗内翻型膝关节骨关节炎的进展[J]. 实用骨科杂志, 2015, 21(6): 529-533.
[20] Paccola CA, Fogagnolo F. Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex[J]. Knee Surg Sports Traumatol Arthrosc, 2005, 13(1): 19-22.
[21] Holschen M, Lobenhoffer P. Complications of corrective osteotomies around the knee[J]. Orthopade, 2016, 45(1): 13-23.
[22] 尚延春, 张海英, 张江涛, 等. 胫骨高位截骨手术治疗膝内翻型骨性关节炎长期随访分析[J]. 中国矫形外科杂志, 2007, 15(13): 973-975. SHANG Yanchun, ZHANG Haiying, ZHANG Jiangtao, et al. Long-term follow-up and analysis of high tibial osteotomy in the treatment of varus knee osteoarthritis[J]. Orthopedic Journal of China, 2007, 15(13): 973-975.
[23] Smith TO, Sexton D, Mitchell P, et al. Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes[J]. Knee, 2011, 18(6): 361-368.
[24] Koshino T, Yoshida T, Ara Y, et al. Fifteen to twenty-eight years' follow-up results of high tibial valgus osteotomy for osteoarthritic knee[J]. Knee, 2004, 11(6): 439-444.
[25] Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years[J]. J Bone Joint Surg Am, 2003, 85(3): 469-474.

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