改良内侧撑开楔形胫骨高位截骨矫正老年膝内翻的临床研究  

Improved medial open-wedge high tibial osteotomy for the correction of knee varus in elderlys

作　　者：刘云峰 李红玲 张伟 周嘉顺 章瑛[3] 

机构地区：[1]河南省焦作市第五人民医院骨科,454150 [2]山东省梁山仁和医院,济宁272600 [3]广州医学院第一附属医院康复科,510120

出　　处：《中华关节外科杂志（电子版）》2013年第2期23-26,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探索高龄(>60岁)膝关节内侧骨关节炎并膝内翻畸形患者的手术技术及疗效。方法 2010年3月至2012年3月,采用改良内侧撑开楔形胫骨高位截骨矫正老年膝内翻畸形46例(52膝)。术前、后均拍患肢全长站立位X线片,测量髋(髋关节中心)-膝(膝关节中心)-踝(踝关节中心)形成的机械轴角度(HKA角),拍侧位X线片,测量胫骨平台后倾角,应用膝关节外科KOOS问卷评分标准对治疗后疗效评估。结果术后有32例(34膝)获随访,其余14例(18膝)因手术后不足3个月被排除在本组样本之外。32例随访时间为3～20个月,平均12.6个月。HKA角从术前(167.6°±3.7°)增加至术后平均(184.5°±1.2°)(P<0.05),胫骨平台后倾角术前平均(12.8°±1.3°),术后纠正到平均(9°±0.9°)(P<0.05);术后第2天带引流管直腿抬高、主动屈、伸膝关节锻炼;第3天,扶走步器负重行走;术后第7天生活已基本恢复自理;术后8～12周截骨端临床愈合。所有患者无一例感染、迟缓愈合、患肢无缺血及感觉障碍等并发症。疗效评估根据手术前、后的膝关节外科KOOS问卷评分结果,术前KOOS评分为(44.1±10.8)分,术后KOOS评分提高到(62.31±11.2)分,通过SPSS20统计学配对样本t检验确定其结果(P<0.05)有统计学差异。结论改良内侧撑开楔形胫骨高位截骨矫正老年膝内翻,是一种适合60岁以上患者的有效方法之一。不仅手术方法简便、组织损伤小、出血少、不易发生并发症,而且术后恢复快、住院时间短、不需要特殊昂贵的耗材,容易被广大患者接受,具有良好的社会效益和经济效益。Objective To explore the efficacy of medial open-wedge high tibial osteotomy （HTO） in the treatment for patients of advanced age （ 〉 60 years） with medial osteoarthritis and varus deformity. Methods From March 2010 to March 2012, 46 randomized consecutive elderly patients （52 knees） were treated by improved medial open-wedge HTO. X-ray films of total limb length were taken before and after surgery, and the HKA （ hip center-Knee center-Ankle center） angle of mechanical axis was measured. The lateral radiograph was taken to measure posterior slope angle of tibial plateau. The KOOS questionnaire score was used to assess the therapeutic effects. Results 32 cases （34 Knees ） were followed up, the other 14 cases （18 knees） which were less than three month after surgery, were excluded. 32 cases were followed up with an average time of 12. 6 months （3 to 20 months）. The average HKA angle increased from （ 167. 6° ± 3.7°） preoperatively to （ 184. 5° ± 1.2°） postoperatively （ P 〈 0. 05 ）. The posterior slope angle of tibial plateau decreased from （ 12. 8 ° ± 1.3 ° ） preoperatively to （9 ° ±0. 9 ° ） postoperative ly （ P 〈 0.05）. On the second day after surgery, the patients began straight leg raising, as well as active flexionand extension knee exercises with a drainage tube. On the third day, the patients began weight-bearing walking with walking device. On the seventh day after surgery, the patients restored the basic self-care. The clinical healing was achieved in 8 to 12 weeks after surgery. There were no infections, slow healing, limb ischemia and sensory dysfunction and other complications in all patients. The KOOS Questionnaire scores were （44. 1 ± 10. 8 ）preoperatively and （62. 31 ± 11.2） postoperatively. According to SPSS 20 statistical paired sample t-test, the results （P 〈 0. 05 ） were significantly different. Conclusions Improved medial open-wedge HTO is a suitable and effective method for treatment of the medial knee varus with

关 键 词：骨关节炎 膝 胫骨高位截骨术 撑开楔形截骨术 

分 类 号：R687.3[医药卫生—骨科学]