胫骨高位闭合截骨与开放截骨对胫骨后倾及髌骨高度的影响  

Effects of high tibia closed osteotomy and open osteotomy on posterior tibia slope and patellar height

作　　者：及松洁[1] 黄野[1] 王达成[1] 张金庆[1] 李玉军[1] 姜旭[1] 周一新[1] JI Song-jie;HUANG Ye;WANG Da-cheng;ZHANG Jin-qing;LI Yu-jun;JIANG Xu;ZHOU Yi-xin(Department of Adult Joint Reconstruction Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《基础医学与临床》2020年第10期1394-1398,共5页Basic and Clinical Medicine

基　　金：北京积水潭医院青年人才培养学科新星计划(XKXX2018)。

摘　　要：目的比较行胫骨高位闭合截骨与开放截骨的临床结果,以及胫骨后倾和髌骨高度的变化。方法收集2017年1月至2018年6月施行的120例(155膝)胫骨高位截骨术患者。20例(25膝)用胫骨外侧闭合楔截骨(LCWHTO),100例(130膝)用胫骨内侧开放楔截骨(MOWHTO)。随访时间分别为20.7个月和18.9个月。于末次随访评价两组患者Lysholm评分、关节活动度(ROM)。对比术前术后机械轴偏移(MAD)、胫骨近端内侧角(MPTA)、胫骨平台后倾角(PTS)的变化和M-K指数。结果LCWHTO组术后M-K指数为0.79±0.07,术后为0.78±0.08,术前术后变化无统计学意义。MOWHTO组M-K指数术后为0.75±0.05显著高于术前0.78±0.05(P<0.05)。LCWHTO组术后PTS为8.1°±3.4°,显著低于术前的10.8°±3.0°(P<0.05);MOWHTO组术后PTS为10.9°±4.0°,术前为10.2°±3.1°,术前术后变化无统计学意义。结论LCWHTO与MOWHTO都能获得满意的临床结果。LCWHTO会减小胫骨后倾,对髌骨高度没有影响。MOWHTO对胫骨后倾没有影响但是会减小髌骨高度。应按照患者具体情况个体化地选择截骨方式。Objective To compare the clinical outcomes of high tibial closed osteotomy and open osteotomy,as well as the changes in posterior tibia slope and patellar height.Methods A total of 120 patients(155 knees)with high tibial osteotomy performed from January 2017 to June 2018 were collected.Twenty cases(25 knees)used lateral tibial closed wedge osteotomy(LCWHTO),and 100 cases(130 knees)used medial tibial open wedge osteotomy(MOWHTO).The follow-up time was 20.7 months and 18.9 months respectively.Lysholm score and joint mobility(ROM)were evaluated at the last follow-up.The changes of mechanical axis deviation(MAD),proximal medial tibial angle(MPTA),posterior tibia slope(PTS)and M-K index were compared between the two groups of patients.Results In the LCWHTO group,the M-K index was 0.79±0.07 after operation and 0.78±0.08 after operation.There was no change before and after operation 0.78±0.05 before MOWHTO operation was significantly higher than 0.75±0.05 after operation(P<0.05).The postoperative PTS in the LCWHTO group was 8.1°±3.4°,which was significantly lower than the preoperative 10.8°±3.0°(P<0.05);the postoperative PTS in the MOWHTO group was 10.9°±4.0°,and 10.2°±3.1°before operation.No change before and after operation.Conclusions Both LCWHTO and MOWHTO can obtain satisfactory clinical outcomes.LCWHTO reduces PTS and has no effect on the patellar height.MOWHTO has no effect on PTS,but it reduces the patellar height.The choice of osteotomy should be individualized according to the characteristics of the patients.

关 键 词：胫骨高位截骨 开放楔 闭合楔 胫骨后倾 髌骨高度 

分 类 号：R683[医药卫生—骨科学]