内侧开放楔形胫骨高位截骨术后近期并发症的临床分析  

Analysis of complications after medial opening wedge high tibial osteotomy

作　　者：朱佳旺 陈德生[1] 王同富 赵军伟 谢洋 Zhu Jiawang;Chen Desheng;Wang Tongfu;Zhao Junwei;Xie Yang(Department of Sports Medicine and Arthroscopy,Tianjin Hospital,Tianjin 300210,China)

机构地区：[1]天津医院运动损伤与关节镜一科,300210

出　　处：《中华外科杂志》2020年第6期447-451,共5页Chinese Journal of Surgery

摘　　要：目的探讨膝关节骨关节炎(OA)患者行内侧开放楔形胫骨高位截骨术(MOWHTO)术后近期并发症及其对临床效果的影响。方法回顾性分析2017年4月至2018年9月于天津医院运动损伤与关节镜一科接受MOWHTO治疗的131例膝关节OA患者的临床资料。男性75例,女性56例,年龄(62.8±5.1)岁(范围:48~70岁)。统计患者术后并发症发生情况,并比较出现并发症患者与未出现并发症患者手术前及术后1年胫骨近端内侧角(MPTA)、国际膝关节文献委员会主观膝部评估表(IKDC)评分、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、膝关节损伤和骨关节炎评分(KOOS)的差异。手术前后指标的比较采用配对样本t检验,组间测量值的比较采用独立样本t检验或χ^2检验。结果随访时间(18.5±3.4)个月(范围:13~22个月)。131例患者中,共22例患者出现并发症(16.8%),其中血肿8例(6.1%),神经感觉异常5例(3.8%),肌间静脉血栓4例(3.1%),深静脉血栓2例(1.5%),其中1例行血管外科手术治疗(0.8%),矫正角度丢失3例(2.3%),浅表感染3例(2.3%),深部感染2例(1.5%),其中1例取出内固定(0.8%),骨折延迟愈合2例(1.5%),术后僵硬1例(0.8%),铰链点皮质骨折1例(0.8%)。并发症组和非并发症组术后1年随访时的MPTA[(86.5±2.0)°比(86.7±2.1)°,t=-0.41,P=0.68]、IKDC评分[(86.4±4.8)分比(85.5±6.9)分,t=0.74,P=0.50]、WOMAC骨关节炎指数[(87.7±6.5)分比(86.1±5.8)分,t=1.16,P=0.25]均无差异;并发症组患者KOOS中的疼痛、运动休闲评分低于非并发症组[(79.4±4.4)分比(87.2±5.9)分,t=-5.90,P<0.01;(83.2±3.0)分比(88.0±4.7)分,t=-6.14,P<0.01],其他项目评分的差异无统计学意义(P值均>0.05)。结论MOWHTO术后最常见并发症为血肿,早期诊断和个体化治疗可以妥善处理MOWHTO术后早期并发症,不会对患者膝关节功能恢复产生明显负面影响。Objective To analyze the incidence of recent complications in patients with osteoarthritis of the knee(OA)after medial opening wedge high tibial osteotomy(MOWHTO)and its influence on clinical effect.Methods The clinical data of 131 patients with knee OA who received MOWHTO at Department of Sports Medicine and Arthroscopy,Tianjin Hospital from April 2017 to September 2018 were analyzed retrospectively.There were 75 males and 56 females,aged(62.8±5.1)years(range:48 to 70 years).Complications and clinical outcomes of patients were recorded and the proximal medial angle of tibia(MPTA),the International Knee Documentation Committee Subjective Knee Form(IKDC),the Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome score(KOOS)were collected before and 1 year after operation and compared between complication group and non-complication group.Data were analyzed by paired-samples t test,independent samples t test andχ^2 test.Results The follow-up time was(18.5±3.4)months(range:13 to 22 months).Complications occurred in 22 patients(16.8%),including 8 cases(6.1%)of hematoma,5 cases(3.8%)of neurosensory abnormality,4 cases(3.1%)of intramuscular venous thrombosis,2 cases(1.5%)of deep venous thrombosis,3 cases(2.3%)of loss of correction angle,3 cases(2.3%)of superficial infection,2 cases(1.5%)of deep infection,2 cases(1.5%)of delayed union of fracture,1 case(0.8%)of postoperative stiffness,1 case(0.8%)of hinge point cortex fracture.There were no significant difference in MPTA((86.5±2.0)°vs.(86.7±2.1)°,t=-0.41,P=0.68),IKDC((86.4±4.8)vs.(85.5±6.9),t=0.74,P=0.50),WOMAC((87.7±6.5)vs.(86.1±5.8),t=1.16,P=0.25).There were no significant difference in knee scores except for the KOOS pain score((79.4±4.4)vs.(87.2±5.9),t=-5.90,P<0.01)and sports and recreation score((83.2±3.0)vs.(88.0±4.7),t=-6.14,P<0.01).Conclusion Short-term complications of MOWHTO can be managed appropriately through early diagnosis and individualized treatment and have no significant negative ef

关 键 词：截骨术 胫骨 内侧开放楔形胫骨高位截骨术 并发症 临床分析 

分 类 号：R687[医药卫生—骨科学]