胫骨高位楔形截骨治疗创伤性膝关节内翻畸形的临床研究  

The clinical research of high tibial Wedge osteotomy in the treatment of varus knee deformity

作　　者：张海宁[1] 王英振[1] 吕成昱[1] 王湘达[1] 王昌耀[1] 

机构地区：[1]青岛大学医学院附属医院关节外科,266003

出　　处：《中华关节外科杂志（电子版）》2009年第3期4-7,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金资助项目(30801167)

摘　　要：目的探讨胫骨高位楔形截骨治疗成人膝关节内翻畸形并发单间室退变的应用价值。方法在2000年6月至2008年6月间,对11例(男7例,女4例,平均39岁)存在膝关节内侧单间室退行性改变伴内翻畸形患者进行胫骨高位楔形截骨术治疗。术前膝内翻畸形4°～18°,平均10.5°;不伴有其他关节间室病变;6例伴有内、外侧副韧带或交叉韧带断裂,行韧带重建手术后二期进行截骨矫形术。术前膝关节症状以内侧间室疼痛为主。8例行闭合型楔形截骨术,3例行开放型楔形截骨术,手术前后测量患者关节活动度的大小,并对患者进行Lysholm评分,术前平均41.5分。术后对患者进行主观满意度调查。结果术后随访平均22.5个月。无神经血管损伤,内固定失败等并发症出现,截骨处均获得骨性愈合,矫正角度5°～17.5°。X线检查下肢力线维持在术后水平,关节间室均未发现明显退变进展。手术总体效果优良率为90.9%,术后Lysholm评分平均72.5分(t=-26.65,P<0.01),内翻角度术后为1.05°(t=4.49,P<0.01)。结论胫骨高位楔形截骨术可有效用于中青年膝关节内翻畸形伴单间室退行性改变患者。Objective To assess the effect of high tibial osteotomy in adult varus knee complicated with unicompartmental degeneration. Methods Eleven patients with varus knee deformity and degeneration in the medial compartment received closed or opening high tibial Wedge osteotomy in our department from June 2000 to June 2008. Deformity before operation was about 10. 5° without any degenerative chan- ging in other compartments of the knee. The range of motion was more than 90°. Six patients had rupture of collateral ligament or cruciate ligament, who underwent osteotomy after reconstruction of the ligaments. The main symptom before operation was pain in medial compartment. The range of motion, Lysholm score and subjective satisfactory examination were assessed and compared before and after osteotomy. Results The mean follow-up was 22. 5 months. No complications like neurovascular injury or fixate failure occurred. All of the osteotomy sites were healed successfully. The correct angle was 5°- 17.5°. The overall satisfactory rate was 90. 9%. Force line of the lower extremities maintained during the follow-up. Statistically significant changing existed in the Lysholm score and varus degree. Conclusions The high tibial osteotomy is an effective method for the symptomatic genu varum with unicompartmental degeneration.

关 键 词：膝 畸形 截骨术 

分 类 号：R687.3[医药卫生—骨科学]