股骨胫骨双截骨治疗严重膝内翻畸形的手术策略及中期临床结果  

The Strategy of Double Level Osteotomy for Osteoarthritis Knees with Severe Varus Deformity And The Mid-Term Results

作　　者：柳剑[1] 王兴山[1] 刘源[1] 黄野[1] Liu Jian;Wang Xingshan;Liu Yuan;Huang Ye(Adult Reconstruction Department,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：《实用骨科杂志》2022年第10期865-869,共5页Journal of Practical Orthopaedics

摘　　要：目的回顾性研究股骨胫骨双截骨治疗严重膝内翻患者的临床影像结果及中期临床结果。方法回顾性研究2016—2018年在北京积水潭医院实施股骨胫骨双截骨的21例膝内翻病例资料,其中男5例,女16例;年龄25~68岁,平均(47.7±11.8)岁。手术前后均行力线分析,包括测量:股胫角(femorotibial angle,FTA),股骨远端外侧角(lateral distal femoral angle,LDFA),胫骨近端内侧角(medial proximal tibial angle,MPTA)和关节线汇聚角(joint-line convergence angle,JLCA)。Miniacci法进行截骨的术前设计,分享手术策略,分析术中及术后并发症,临床结果采用牛津膝关节评分(Oxford knee score,OKS)进行评价。结果术前FTA(162.1±7.6)°,MPTA(79.5±6.2)°,LDFA(98.1±7.4)°,JLCA(2.1±2.7)°;术后FTA(178.2±5.6)°,MPTA(89.5±2.6)°,LDFA(90.8±5.2)°,JLCA(1.5±1.3)°。术前术后MPTA、LDFA及FTA比较差异有统计学意义(P<0.05)。患肢股骨侧胫骨截骨均采用Tomofix内固定,虽然有合页断裂,但最终均获得愈合。21例患者均获得随访,术后平均随访时间为(5±1)年,最后一次采用电话随访,OKS平均为(44±3)分。结论股骨胫骨双截骨能够有效纠正患者下肢畸形并保持关节线处于生理状态。采用Tomofix坚强内固定保证了骨端的稳定性,即使在合页断裂的情况下,单钢板固定仍然保证了骨端的顺利愈合。Objective To retrospective evaluate the clinical and radiologic results of double level osteotomy(DLO)for osteoarthritis knees with severe varus deformity and mid-term results.Methods The patients in Beijing Jishuitan Hospital between 2016-2018 who underwent DLO for osteoarthritis knees with severe varus deformity were retrospectively studied.21 patients,including 5 males and 16 females were ultimately enrolled.The age ranged form^(2)5 to 68,with an average age of(47.7±11.8)years.All patients underwent radiological assessment.In the radiological assessment,the following parameters were measured on full-length weightbearing radiographs both pre-and postoperatively:femorotibial angle(FTA),lateral distal femoral angle(LDFA),medial proximal tibial angle(MPTA),and joint-line convergence angle(JLCA).In addition,we shared the experience of preoperative planning using Miniacci methods and surgical strategy.We also analyzed the reasons and results of intro-operative and post-operative complications.Clinical results were evaluated using the Oxford knee score(OKS)e.Results The preoperative FTA,LDFA,MPTA,and JLCA values averaged(162.1±7.6)°varus,(79.5±6.2)°,(98.1±7.4)°,and(2.1±2.7)°,respectively.The postoperative FTA,LDFA,MPTA,and JLCA values averaged(178.2±5.6)°varus,(89.5±2.6)°,(90.8±5.2)°,and(1.5±1.3)°,respectively.All of the radiological parameters significantly improved and corrected to the values within normal range(P<0.05).All osteotomy sites were fixed with Tomofix plate,and healed well even with hinge fracture.All patients were followed up for(5±1)years.The OKS was(44±3)in the last phone interview.Conclusion The DLO technique is a valuable surgical technique accomplishing restoration of physiologic knee joint alignment and orientation with significant improvement.The bone healing rate was 100%even with hinge fracture using single plate fixation because all osteotomy sites were fixed with Tomofix locking plate system which is a rigid fixation.

关 键 词：股骨胫骨双截骨 膝内翻 胫骨高位截骨 Tomofix 膝关节骨关节炎 

分 类 号：R687.31[医药卫生—骨科学]