矢状面楔形撑开对内侧开放楔形截骨术后胫骨平台后倾角的影响  

Effect of Sagittal Wedge Distraction on the Posterior Inclination of the Tibial Plateau After a Medial Opening Wedge High Tibial Osteotomy

作　　者：张嘉贺 孙玖阳 杨久山[2] Zhang Jiahe;Sun Jiuyang;Yang Jiushan(The First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Orthopaedics of Sports Injury,Shandong Hospital of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]山东省中医院运动损伤骨科,山东济南250014

出　　处：《实用骨科杂志》2023年第10期903-906,915,共5页Journal of Practical Orthopaedics

摘　　要：目的研究内侧开放楔形胫骨高位截骨术(opening-wedge high tibial osteotomy,OWHTO)治疗膝骨关节炎(knee osteoarthritis,KOA)术中矢状面楔形撑开对胫骨平台后倾角(posterior tibial slope,PTS)的影响。方法回顾性分析2019年1月至2020年7月,山东省中医院运动损伤骨科接受OWHTO治疗的63例KOA患者的临床资料。研究组31例,其中男13例,女18例;年龄50~65岁,平均(56.29±3.49)岁;身体质量指数(body mass index,BMI)为(26.48±1.77)kg/m~2;按照上下1/2~2/3的近似比例在矢状面楔形撑开截骨间隙。对照组32例,男14例,女18例;年龄49~59岁,平均(55.66±2.66)岁;BMI(27.13±2.39)kg/m~2;常规撑开间隙。术前两组患者性别、年龄、BMI、疼痛视觉模拟评分(visual analogu scale,VAS)、美国特种外科医院(hospital for special surgery,HSS)评分、Lysholm评分、PTS等差异均无统计学意义(P>0.05)。术后1周之内首次拍片和末次随访时测量PTS并与术前比较;术前及末次随访时采用VAS评分、HSS评分和Lysholm评分评估患者膝关节疼痛及功能情况。结果两组患者均获随访,随访时间22~32个月,平均(26.81±2.12)个月。两组患者均未出现血管神经损伤、下肢静脉血栓形成等并发症。末次随访时,两组患者VAS评分、HSS评分和Lysholm评分均较术前显著改善,差异有统计学意义(P<0.05);但组间各评分在各时间点的比较,差异均无统计学意义(P>0.05)。研究组各时间点PTS差异均无统计学意义(P>0.05);对照组术后及末次随访时PTS较术前明显增加(P<0.05);术后及末次随访时研究组患者PTS均显著小于对照组,差异有统计学意义(P<0.05)。结论采用OWHTO治疗KOA能有效缓解膝关节疼痛并改善其功能,且通过矢状面楔形撑开可有效避免PTS的增加。Objective To investigate the effect of sagittal plane wedge opening on the posterior tibial slope(PTS)during the surgical treatment of knee osteoarthritis(KOA)using medial opening-wedge high tibial osteotomy(MOWHTO).Methods A retrospective analysis was conducted on clinical data from 63 KOA patients who underwent MOWHTO treatment in Shandong Hospital of Traditional Chinese Medicine between January 2019 and July 2020.The experimental group included 31 patients,consisting of 13 males and 18 females,with an average age of(56.29±3.49)years and a mean body mass index(BMI)of(26.48±1.77)kg/m 2.The patients in this group underwent tibial osteotomy with approximate sagittal plane wedge opening between the lower 1/2 to 2/3 of the tibia.The control group included 32 patients,consisting of 14 males and 18 females,with an average age of(55.66±2.66)years and a mean BMI of(27.13±2.39)kg/m 2,who underwent conventional osteotomy.Before the surgery,there were no statistically significant differences(P>0.05)between the two groups regarding gender,age,BMI,preoperative visual analogue scale(VAS)pain scores,hospital for special surgery(HSS)scores,Lysholm scores,PTS,or other baseline characteristics.The first X-ray examination was performed within one week after surgery,and PTS was measured during the final follow-up,which was then compared with the preoperative measurement.The knee joint pain from patients and the functional status were also assessed using VAS scores,HSS scores,and Lysholm scores before surgery and at the final follow-up.Results Both groups of patients successfully completed the follow-up,with a follow-up period ranging from 22 to 32 months,with an average of(26.81±2.12)months.No complications such as vascular or neural injuries or lower limb venous thrombosis were observed in either group.At the final follow-up,both groups showed significant improvements in VAS scores,HSS scores,and Lysholm scores compared to preoperative values,with statistically significant differences(P<0.05).However,there were no significant

关 键 词：矢状位 楔形撑开 内侧开放楔形截骨 胫骨平台后倾角 

分 类 号：R687.31[医药卫生—骨科学]