微创倒U形胫骨高位截骨联合孟氏外固定架治疗膝关节骨性关节炎并膝内翻5年随访观察  

Minimally invasive technique of inverted U-shaped high tibia osteotomy with Menghe external fixator in treatment of varus knee osteoarthritis: a 5-year follow-up

作　　者：庄至坤 吴昭克 龚志兵 朱勇[2] 徐福东[2] 

机构地区：[1]福建中医药大学,福建福州350003 [2]福建中医药大学附属泉州市正骨医院关节骨病科

出　　处：《中国骨与关节损伤杂志》2015年第8期815-817,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的 观察微创倒U形胫骨高位截骨联合孟氏外固定架治疗膝关节骨性关节炎并膝内翻5年随访结果。方法 自2007-02—2009-07采用微创倒U形胫骨高位截骨联合孟氏外固定架治疗膝关节骨性关节炎并膝内翻60例。采用VAS评分评估膝关节疼痛程度,KSS评分评估膝关节功能,SF-36量表评价生存质量,摄膝关节负重正侧位X线片观察截骨端愈合情况并进行Kellgren-Lawrence分级评价骨性关节炎进展程度。结果 本组共有48例获得5年以上随访,随访时间60-89个月,平均66个月。3例在治疗过程中出现针眼渗出,伤口分泌物细菌培养均为阴性,经积极处理后愈合。所有患者内翻畸形均得到矫正,随访期间未发现截骨矫形角度丢失。末次随访时,48例VAS评分（1.06±0.42）分,较术前（7.35±1.91）分明显降低,差异有统计学意义（P〈0.001）;KSS评分（89.0±5.9）分,较术前（74.6±5.5）分明显提高,差异有统计学意义（P〈0.05）;SF-36量表中生存质量8个维度评分均较术前提高,差异有统计学意义（P〈0.05）。以膝关节正位X线片Kellgren-LawrenceⅣ级作为终点事件,末次随访时膝关节保存率为95.8%。结论 微创倒U形胫骨高位截骨联合孟氏外固定架治疗膝关节骨性关节炎并膝内翻创伤小、恢复快,可矫正膝内翻畸形及下肢力线,缓解疼痛,改善关节功能,提高患者生存质量,延缓甚至避免关节置换。Objective To observe the result of a 5-year follow-up of minimally invasive technique of inverted U-shaped high tibia osteotomy with Menghe external fixator in the treatment of varus knee osteoarthritis. Methods From Feb. 2007 to July 2009, 60 patients with varus knee osteoarthritis underwent minimally invasive technique of inverted U-shaped high tibia osteotomy with Menghe external fixator in our department. The progression of OA of all cases wasevaluatedby VAS score, KSS score, SF-36 scale and Kellgren-Lawrence grading. Results Forty eight patients were followed-up for 60 to 89 months（mean 66 months）. Three patients had exudation in the pinholes, no bacterial was found out after cultures, and all these pinholes healing after active treatment. The varus of all patients was corrected without osteotomy angle missing during observation process. At last postoperative follow-up, VAS score was decreased after operation （P 〈0.001）, the average scores were from （7.35±1.91） to （1.06±0.42）. KSS scores improved from （74.6±5.5） to （89.0±5.9）. The SF-36 scale was improved by 8 degrees （P 〈0.05）. By using the Kellgren-Lawrence IV level as the end point events, the survival rate of knee joint at the last follow- up time was 95.8%. Conclusion Minimally invasive inverted U-shaped high tibia osteotomy with Menghe external fixator with less trauma and quicker recover, can correct genu varus deformity and change the force line of lower limb, relieve pain, improve joint function, improve quality of life and delay or even avoid joint replacement.

关 键 词：膝关节骨性关节炎 膝内翻 微创 截骨术 孟氏外固定架 

分 类 号：R687.31[医药卫生—骨科学]