胫骨高位截骨治疗膝骨性关节炎中长期疗效分析  

Medium and long-term results of high tibial osteotomy for the treatment of knee joint osteoarthritis

作　　者：侯延超[1] 魏杰[2] 贾中伟[2] 王晓东[2] HOU Yan-chao WEI Jie JIA Zhong-wei WANG Xiao-dong(The People Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,Shanxi, China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学附属人民医院,山西太原030012

出　　处：《中国骨伤》2016年第9期795-799,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：分析胫骨高位截骨治疗膝骨性关节炎的中长期疗效。方法 ：自2001年1月至2005年12月,采用胫骨高位截骨术治疗45例63膝关节内侧间室骨性关节炎患者,男10例（15膝）,女35例（48膝）;年龄45～64岁,平均（54.76±5.54）岁。术前常规行膝关节负重正侧位X线检查,准确测量股胫角大小,根据术前股胫角决定胫骨外侧截骨量,手术均在硬膜外麻醉下常规行胫骨高位截骨术,大部分行腓骨中段截骨,部分病例行上胫腓关节松解。术后第2天即行功能锻炼,2周开始无负重下床活动,术后8～10周开始负重。术后第2天、8～10周、半年、1年及以后每年1次拍片复查,对全部病例术前、术后3～5年、术后10～14年采用视觉模拟评分（VAS）、美国特种外科医院膝关节评分（HSS）和美国膝关节协会评分（KSS）评价膝关节疼痛、畸形、功能和运动范围。结果 ：43例（61膝）进行了10年及以上的随访,全部患者手术切口Ⅰ期愈合,术后8～10周截骨处均达骨性愈合。术后10～14年HSS评分平均76.24±5.27,优27膝,良25膝,可7膝,差2膝。术前与术后3～5年、术前与术后10～14年VAS、HSS、KSS比较有差异,术后3～5年与术后10～14年各项评分无明显差异。结论：胫骨高位截骨治疗膝骨性关节炎（内侧间室关节炎）只要手术指征掌握适当,术后积极锻炼,其中长期疗效满意。Objective：To analyze the medium and long-term results of high tibial osteotomy（HTO） for the treatment of knee joint osteoarthritis（OA）.Methods：From January 2001 to December 2005,45 patients（63 knees）with medial compartment OA were treated with HTO,including 10 males（15 knees） and 35 females（48 knees）,ranging in age from 45 to 64 years old with an average of（55.76±5.54） years old.Preoperative normal anteroposterior and lateral X-ray films of weightbearing knee were conducted,with an accurate measurement of the femoral tibial angle（FTA）,and the mass of lateral tibial osteotomy was determined according to the preoperative FTA.Routine HTO was performed after epidural anesthesia.Most patients were treated with middle part fibulae osteotomy,and some patients were treated with the release of proximal tibiofibular joints.The functional exercise-no weight-bearing ambulation and weight-bearing exercise began on the second day after operation 2 weeks after operation and 8 to 10 weeks after operation respectively.All the cases should be examined with X-ray postoperatively on the second day,8 to 10 weeks,6 months,1 year after operation and once a year.The VAS,HSS and KSS were used to evaluate knee pain,deformity,function,and range of motion preoperatively,3 to 5 years postoperatively,10 to 14 years postoperatively in all the patients.Results：Forty-three patients（61 knees） were followed up for more than 10 years.All the incisions were healed at the first stage.The bone healing was achieved 8 to 10 weeks after operation.The knee joint was evaluated according to the HSS standard 10 to 14 years after operation,and the average score was 76.24±5.27.Twenty-seven patients got an excellent result,25 good,7 fair and 2 poor.The VAS,HSS and KSS scores of postoperative 3 to 5 years and 10 to 14 years were better than those of before operation.There were no obvious differences of scores between postoperative 3 to 5 years and postoperative 10 to 14 years.Conclusion：The long-term curative effect of h

关 键 词：骨关节炎 膝 畸形 胫骨 截骨术 

分 类 号：R684.3[医药卫生—骨科学]