胫骨结节下微创弧形截骨术联合Ilizarov技术治疗膝关节内侧间室骨关节炎  

Minimally invasive curved osteotomy under tibial tuberosity combined with Ilizarov technique in the treatment of medial compartment osteoarthritis of the knee joint

作　　者：浦绍全 廖建青 夏燊 蒙旭晗 陈延岭 赵泽雨 齐欣 浦路桥 梁金龙 徐永清 PU Shaoquan;LIAO Jianqing;XIA Shen;MENG Xuhan;CHEN Yanling;ZHAO Zeyu;QI Xin;PU Luqiao;LIANG Jinlong;XU Yongqing(Department of Orthopaedics,The 920 Hospital of Joint Service Support Force,Kunming 650032,China)

机构地区：[1]联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中华骨与关节外科杂志》2023年第9期779-785,共7页Chinese Journal of Bone and Joint Surgery

基　　金：云南省卫生健康委临床医学中心建设项目(ZX20191001);云南省科技厅重大科技专项计划(202102AA310068)。

摘　　要：目的:探讨胫骨结节下微创弧形截骨术联合Ilizarov技术矫正患者下肢力线来治疗膝关节内侧间室骨关节炎的临床疗效。方法:回顾性分析2018年2月至2022年5月收治的13例(19膝)膝关节内侧间室骨关节炎患者,男8例,女5例,年龄33~56岁,平均(36.0±10.8)岁。对患者行胫骨结节下微创弧形截骨术联合Ilizarov技术,记录环形外固定器拆除时间、术前与术后患侧髋-膝-踝角(HKA)、胫骨近端内侧角(MPTA)、膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)和髌骨高度(ISI)来评估临床疗效。结果:所有患者均顺利完成手术,手术时间38~55 min,平均(45.2±11.6)min;住院时间5~8 d,平均(6.4±1.6)d。患者术后均获得随访,随访时间12~36个月,平均(17.4±6.7)个月,所有患者HKA、MPTA、ROM、VAS评分较术前比较差异有统计学意义(P<0.01),ISI术前与术后比较差异无统计学意义(P>0.05)。术后环形外固定器留置期间有3例患者出现针道红肿,予以换药、酒精湿敷,拆除环形外固定器1周内针道均愈合良好。结论:通过胫骨结节下微创弧形截骨术联合Ilizarov技术治疗膝关节内侧间室骨关节炎,能够有效矫正患者的下肢力线,从而缓解膝关节疼痛。Objective:To investigate the clinical effect of subtubercula tibialis minimally invasive arc-shaped osteotomy combined with Ilizarov circular external fixator for the treatment of medial compartment osteoarthritis of the knee.Methods:A total of 13 patients(19 knees)with medial compartment osteoarthritis of the knee joint who underwent minimally invasive curved osteotomy under tibial tuberosity and Ilizarov technique from February 2018 to May 2022 were enrolled in this retrospective study.There were 8 males and 5 females with a mean age of(36.0±10.8)years(range,33-56 years).The Ilizarov ring external fixator removal time was recorded,and evaluating the varies of hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),range of motion(ROM),visual analogue scale(VAS)score and Insall-Salvati index(ISI).Needle passage redness and swelling occurred in 3 patients during the post-operation period.After dressing change and alcohol wet compress,the needle passage healed well within 1 week after removal of the ring external fixator.Results:The surgery was successfully completed in all the patients.The average operation time was(45.2±11.6)min(range,38-55 min),and the average hospital stay was(6.4±1.6)d(range,5-8 d).All patients were followed up for(17.4±6.7)months on average(range,12-36 months).Postoperative HKA,MPTA,ROM and VAS score were significantly different from preoperative ones(P<0.01).There was no significant difference in ISI before and after the operation(P>0.05).The redness and swelling of the needle passage presented in 3 patients,which were treated with dressing change and alcohol wet dressing,and were healed within 1 week after external fixator removal.Conclusions:The minimally invasive curved osteotomy under tibial tuberosity combined with the Ilizarov circular external fixator in the treatment of medial compartment osteoarthritis of the knee joint can effectively correct the lower limb alignment and relieve knee pain.

关 键 词：ILIZAROV技术 外固定 骨关节炎 截骨术 

分 类 号：R687[医药卫生—骨科学]