数字骨科技术辅助胫骨高位截骨治疗胫骨骨折畸形愈合继发内翻型膝骨关节炎的疗效分析  

Treatment of varus knee osteoarthritis secondary to tibial fracture malunion by high tibial osteotomy assisted by digital orthopedic techniques

作　　者：赵斌[1] 骆巍 叶松庆 柏豪豪 廉子健[1] 姜轩[1] 赵志虎[1] 马信龙[1] Zhao Bin;Luo Wei;Ye Songqing;Bai Haohao;Lian Zijian;Jiang Xuan;Zhao Zhihu;Ma Xinlong(Clinical Application Center of Digital Orthopedic Technology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院数字骨科技术临床应用中心,天津300211

出　　处：《中华创伤骨科杂志》2025年第2期117-124,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家临床重点专科建设项目(数字骨科);中央引导地方科技发展基金(22ZYJDSY00110);天津市卫生健康行业高层次人才选拔培养工程-青年医学新锐(TJSQNYXXR-D2-136);天津市卫生健康科研项目(TJWJ2023QN049)。

摘　　要：目的探讨数字骨科技术辅助胫骨高位截骨术(HTO)治疗胫骨骨折畸形愈合继发内翻型膝骨关节炎的疗效。方法回顾性分析2022年4月至2023年10月期间天津市天津医院数字骨科技术临床应用中心收治的16例胫骨骨折畸形愈合继发内翻型膝骨关节炎患者资料。男6例,女10例;年龄(56.3±1.6)岁;体重指数为(23.8±0.9)kg/m^(2)。所有患者基于数字骨科技术设计并打印个性化截骨矫形一体化导向器,以此为模版进行HTO。若患者术前影像学检查提示存在症状性半月板损伤(撕裂)、关节内游离体或髁间窝狭窄,则于HTO术前进行关节镜下清理,之后同期行HTO。通过测量并比较术前与术后12个月髋-膝-踝角(HKA)、胫骨近端内侧角(MPTA)、胫骨平台后倾角(PTS)、下肢负重力线(WBL)比率、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分、疼痛视觉模拟评分(VAS)和膝关节活动度评定疗效。结果所有患者手术时间为(41.3±2.1)min,术中透视次数均为1次。伤口均一期愈合,无合页点骨折、伤口感染、血管损伤、神经损伤、骨折延迟愈合或不愈合、下肢深静脉血栓形成、内固定松动、接骨板断裂等并发症。16例患者术后获(16.3±0.7)个月随访。术后12个月患者HKA(179.5°±0.5°)、MPTA(91.7°±0.5°)、WBL比率(61.2%±0.4%)、WOMAC骨关节炎指数评分[(12.8±0.8)分]、疼痛VAS评分[(1.8±0.3)分]、膝关节活动度(121.8°±1.8°)均较术前[166.6°±1.3°、81.8°±0.4°、29.6%±1.0%、(38.4±2.1)分、(4.8±0.3)分、110.5°±2.1°]显著改善,差异均有统计学意义(P<0.05);而PTS与术前比较差异无统计学意义(P>0.05)。结论在采用HTO治疗胫骨骨折畸形愈合继发内翻型膝骨关节炎时,应用数字骨科技术辅助可有效改善患者HKA、MPTA、下肢力线及膝关节活动度,减轻患者膝关节疼痛,恢复患者膝关节功能。ObjectiveTo evaluate the clinical effectiveness of high tibial osteotomy(HTO)assisted by digital orthopedic techniques in the treatment of varus knee osteoarthritis secondary to tibial fracture malunion.MethodsThe clinical data were retrospectively analyzed of the 16 patients who had been admitted to Clinical Application Center of Digital Orthopedic Technology,Tianjin Hospital for varus knee osteoarthritis secondary to tibial fracture malunion from April 2022 to October 2023.There were 6 men and 10 women,with an age of(56.3±1.6)years and a mean body mass index of(23.8±0.9)kg/m^(2).HTO was performed for all the patients using patient-specific instrumentation integrated osteotomy and orthopedic guide which was designed and printed with digital orthopedic techniques.If preoperative imaging indicated symptomatic meniscus injury(tear),intraarticular free body,or intercondylar fossa stenosis in a patient,arthroscopic clearance was first conducted before subsequent performance of HTO at one stage.Clinical effectiveness was evaluated by measuring and comparing hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),posterior tibial slope(PTS),lower limb weight-bearing line(WBL)ratio,Western Ontario and McMaster University(WOMAC)osteoarthritis index,visual analogue scale(VAS)pain score and knee range of motion(ROM)before surgery and 12 months after surgery.ResultsThe operative time was(41.3±2.1)min and intraoperative fluoroscopy was performed only once in all the patients.All the wounds healed by the first stage with no such complications as hinge point fracture,wound infection,vascular injury,nerve injury,delayed union or nonunion of fracture,lower limb deep venous thrombosis,loosening of internal fixation,or plate rupture.The follow-up time for the 16 patients was(16.3±0.7)months.At 12 months after surgery,the HKA(179.5°±0.5°),MPTA(91.7°±0.5°),WBL ratio(61.2%±0.4%),WOMAC osteoarthritis index[(12.8±0.8)points],VAS pain score[(1.8±0.3)points]and knee ROM(121.8°±1.8°)were significantly better than thos

关 键 词：胫骨骨折 骨关节炎 膝 膝内翻 截骨术 计算机辅助设计 打印 三维 

分 类 号：R68[医药卫生—骨科学]