开放楔形胫骨高位截骨术截骨间隙处理原则和临床观点  

Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy

作　　者：刘军廷[1] 杨莉平 吴家恒 苏伟[1] 赵劲民[1] LIU Junting;YANG Liping;WU Jiaheng;SU Wei;ZHAO Jinmin(Department of Orthopaedic Trauma and Hand Surgery,the 1st Affiliated Hospital of Guangxi Medical University,Nanning Guangxi,530021,P.R.China)

机构地区：[1]广西医科大学第一附属医院创伤骨科手外科,南宁530021

出　　处：《中国修复重建外科杂志》2020年第7期919-926,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广西科技基地和人才专项(桂科AD17129012);广西大学生创新创业训练计划项目(201910598010);广西医科大学长寿与老年相关疾病教育部重点实验室开放课题(2019)。

摘　　要：目的对开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)截骨间隙的处理原则和临床观点作一综述。方法查阅近年国内外与OWHTO截骨间隙相关的文献,对截骨间隙处理方式进行总结和分析。结果截骨间隙骨延迟愈合、不愈合是OWHTO主要并发症。以Tomofix为代表的锁定钢板具有角稳定特点,能更好地维持截骨端稳定性,促进截骨间隙愈合,避免矫形角度丢失。截骨间隙处理方式有无骨移植、自体骨移植、同种异体骨移植、骨替代材料移植和增强骨愈合的因子移植。对截骨间隙<10 mm者,无骨移植可达到良好愈合;对于肥胖、外侧合页断裂、截骨间隙较大或矫正角度>10°者,应考虑行骨移植治疗。在截骨间隙骨不愈合或延迟愈合的情况下,自体骨移植仍被认为是治疗金标准。截骨间隙应用同种异体骨移植,选择碎片状松质骨或楔形松质骨较好,联合锁定钢板技术也能达到较好骨愈合。截骨间隙应用钙磷类骨替代材料具有骨传导好、生物相容性佳、可吸收的特点,同时应用锁定钢板技术,能实现截骨间隙更好的骨愈合。增强骨愈合的因子对OWHTO截骨间隙愈合的促进作用,有待进一步研究。截骨间隙骨愈合还与撑开间隙大小和外侧合页是否断裂相关。结论截骨间隙不管使用哪种方式进行处理,OWHTO均能改善膝骨关节炎患者的功能和缓解疼痛。OWHTO截骨间隙处理方式何者更优,需要更多的随机对照试验为临床决策提供证据。Objective To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy(OWHTO).Methods The related literature of the osteotomy gap of OWHTO in recent years was reviewed,summarized,and analyzed.Results Delayed union and non-union of the osteotomy gap are main complications of OWHTO.Tomofix plate,as locking steel plate,has the characteristics of angular stability and can better maintain the stability of the osteotomy gap,promote bone healing,and avoid loss of correction.There are some treatment options for the osteotomy gap site,such as,without bone,autologous bone graft,allogeneic bone graft,bone substitute materials graft,and augment factor graft to enhance bone healing.When the osteotomy gap is less than 10 mm,it achieves a good outcome without bone graft.For the obesity,lateral hinge fracture,large osteotomy gap,or correction angle more than 10°,the bone graft should be considered.In cases whose osteotomy gap is nonunion or delayed union,the autologous bone graft is still the gold standard.When the osteotomy gap repaired with the allogeneic bone graft,it is better to choose fragmented cancellous or wedge-shaped cancellous bone,combining with the locking plate technology,also can achieve better bone union.The bone substitute material of calcium-phosphorus is used in the osteotomy gap,which has the characteristics of excellent bone conduction,good biocompatibility,and resorption,combining with the locking plate technology,which can also achieve better bone union in the osteotomy gap.The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable.The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not.Conclusion No matter what type of materials for the osteotomy gap,OWHTO can improve the function and relieve pain for knee osteoarthritis.More randomized controlled trials are needed to provide evidence for clinical decision to determine which treat

关 键 词：开放楔形胫骨高位截骨术 截骨间隙 自体骨移植 同种异体骨移植 骨替代材料 

分 类 号：R687.3[医药卫生—骨科学]