胫骨结节楔形截骨在复杂初次膝关节置换中的应用  

Evaluation of Tibial Tubercle Wedge Osteotomy in Treatment of Severe Stiff Knee with Total Knee Arthroplasty

作　　者：王磊[1] 沈伟中[1] 蒋忠[1] 孙俊英[2] 骆园[1] Wang Lei Shen Weizhong Jiang Zhong(Department of Orthopedics,lst Hospital of Taicang,Taicang 215400,China)

机构地区：[1]江苏省太仓市第一人民医院骨科,江苏太仓215400 [2]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《实用骨科杂志》2016年第12期1077-1079,1090,共4页Journal of Practical Orthopaedics

摘　　要：目的 探讨胫骨结节楔形截骨技术在膝关节僵直患者行初次膝关节表面置换术中的应用,分析其临床疗效及手术技巧,为临床手术方案选择提供参考。方法 2005年5月至2014年10月太仓市第一人民医院及苏州大学附属第一医院共采用膝关节表面置换治疗膝关节僵直患者23例23膝,其中男8例,女15例;年龄52~75岁,平均62岁。从疼痛视觉模拟评分（visual analogue scale,VAS）、膝关节功能评分（knee society score,KSS）及膝关节活动度（range of motion,ROM）方面进行评价。结果 所有患者手术顺利,未发生感染、血管神经损伤、骨折不愈合等并发症。所有患者均获随访,随访时间12~45个月,平均35个月,截骨处均于5个月内愈合。VAS评分由术前平均（5.25±1.56）分（4~8分）降低至术后（1.26±0.64）分（0~4分）,KSS评分由术前平均（42.76±7.80）分（35~56分）提高到术后（90.05±17.24）分（67~92分）,膝关节活动度由术前（52.36±24.45）°（15°~80°）改善为末次随访（90.15±17.56）°（60°~110°）。结论 胫骨结节截骨技术是一种增加膝关节暴露安全有效的方法,楔形截骨可以分散螺钉承载的应力,在截骨块断端间给予持续动力加压,增加截骨块愈合概率,纠正下肢力线,取得满意的临床疗效。Objective To investigate the application of tibial tubercle wedge osteotomy in treatment of severe stiff knee with total knee arthroplasty,analyze the clinical result and surgical technique,and provide reference for the selec-tion of clinical operation.Methods 23 cases diagnosed as stiff knee since May 2005 to October 2014 underwent total knee arthroplasty.All patients were followed up,mainly evaluated from the visual analog scale （VAS）,the function of the knee score （KSS）and range of motion （ROM）.Results All the patients were successfully performed without any severe complications.All patients with osteotomy healed within 5 months,VAS score reduced by preoperative （5.25± 1.56）points （range 4~8 points）to postoperative （1.26±0.64）points （range 0~4 points）,KSS score improved from preoperative （42.76 ± 7.80）points （range 35~56 points）to postoperative （90.05 ± 17.24）points （range 67~92 points）.Knee range of move improved from preoperative （52.36±24.45）°（range 15°~80°）to （90.15±17.56）°（range 60°~ 110°）at the time of last follow-up.Conclusion Tibial tubercle wedge osteotomy technique is an effective and safe approach to increase the exposure of the knee joint,wedge osteotomy can disperse the stress loaded on screws,and give continuous dynamic compression between fractures to increase the healing rate.Wedge osteotomy also can correct align-ment of the lower limbs to obtain good clinical results.

关 键 词：膝关节僵直 人工膝关节置换 胫骨结节楔形截骨 

分 类 号：R687.42[医药卫生—骨科学]