开放式楔形胫骨高位截骨术在膝骨关节炎中的应用  

Application of open wedge high tibial osteotomy in treatment of knee osteoarthritis

作　　者：朱旭[1] 张林 进晓辉 曾纪洲[1] 张亚奎[1] Zhu Xu;Zhang Lin;Jin Xiaohui;Zeng Jizhou;Zhang Yakui(Department of orthopedics, Beijing Luhe Hospital affiliated to Capital Medical University, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京潞河医院骨科,北京101149

出　　处：《中华关节外科杂志（电子版）》2020年第6期769-772,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：首都临床特色临床应用研究项目培育专项(KJ2018CX009-18);北京市通州区高层次人才发展支持计划领军人才资助项目(YHLD2017009)。

摘　　要：目的观察采用开放式楔形胫骨高位截骨术(OWHTO)治疗合并膝内翻的内侧间室膝骨关节炎的安全性和有效性。方法收集2018年1月至2020年1月于首都医科大学附属北京潞河医院骨科接受OWHTO治疗的96例膝关节骨关节炎患者的临床资料,采用配对样本t检验对比分析术前和术后髋膝踝角(HKA)、疼痛视觉模拟评分(VAS)、美国膝关节协会评分(KSS),统计手术时间、术中出血量、切口长度和术后并发症发生率。结果96例患者均获得随访,随访时间6~30个月,所有患者的膝内翻畸形均获得矫正。手术时间(98±8)min、术中出血量(278±58)ml、切口长度(7.2±1.8)cm;术后髋-膝-踝角(HKA)由术前的(186.2±1.5)°降至(180.4±1.2)°(t=5.19,P<0.05);术后1月视觉模拟评分法(VAS)评分由术前(2.8±1.3)分降低至术后(1.1±0.4)分(t=4.82,P<0.05);美国膝关节协会评分(KSS)临床评分由术前的(59.8±4.4)分增加至术后的(81.5±6.5)分(t=-13.17,P<0.05);KSS功能评分由术前的(60.2±11.4)分增加至术后(82.7±7.7)分(t=-10.56,P<0.05);术后Caton-Deschamps指数(CDI)为(0.91±0.12),无低位髌骨发生;术后截骨处均愈合,术后并发症共5例(5.2%),其中切口感染2例、皮下血肿3例。结论对于合并有膝内翻的内侧间室膝骨关节炎,OWHTO是一种安全、有效的可选方案,临床中应严格把握适应证,遵从操作规范以减少并发症的发生。Objective To evaluate the safety and efficacy of open wedge high tibial osteotomy(OWHTO)in the treatment of Medial compartment knee osteoarthritis associated with varus deformity.Methods Clinical data of 96 patients with knee osteoarthritis who received OWHTO treatment in the department of orthopedics of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2018 to January 2020 were collected.The preoperative and postoperative hip-knee-ankle(HKA),visual analogue scale(VAS)of pain,American Knee Society score(KSS)were compared and analyzed by pared-samples t test.The operative time,intraoperative blood loss,incision length,and postoperative complication incidence was calculated.Results All the 96 patients were followed up for six to 30 months.All the patients were corrected for extraarticular deformities.The operation time was(98±8)min,the intraoperative blood loss was(278±58)ml,and the incision length was(7.2±1.8)cm.The hip knee ankle angle(HKA)decreased from(186.2±1.5)°to(180.4±1.2)°(t=5.19,P<0.037).The visual analogue scale(VAS)score decreased from(2.8±1.3)preoperatively to(1.1±0.4)postoperatively(t=4.82,P<0.043),The clinical score of KSS increased from(59.8±4.4)preoperatively to(81.5±6.5)postoperatively(t=-13.17,P<0.011).KSS functional score increased from(60.2±11.4)preoperatively to(82.7±7.7)after operation(t=-13.17,P<0.019).The postoperative Caton Deschamps index(CDI)were(0.91±0.12),and the condition of patella baja did not occur.All the osteotomies healed and only five cases encountered complications(5.2%),including two cases of fever incision infection and three cases of subcutaneous hematoma.Conclusions OWHTO is a safe and effective alternative for medial compartment knee osteoarthritis with Varus deformity.Indications should be strictly observed in clinical practice.Operation specifications should be followed to reduce the occurrence of complications.

关 键 词：胫骨 截骨术 关节炎 膝 评价研究 

分 类 号：R687.4[医药卫生—骨科学]