截骨导向器辅助胫骨高位截骨的临床效果研究——一项前瞻性随机对照研究  

Clinical effect study of bone cutting guide assisted high tibial osteotomy-a prospective randomized controlled study

作　　者：王鑫[1] 赵润凯 任海潮 樊梦琳 徐顺利 张国强[2] Wang Xin;Zhao Runkai;Ren Haichao(Department of Orthopedics,First People's Hospital of Xinxiang City,Affiliated People's Hospital of Xinxiang Medical College,Xinxiang 453003,China)

机构地区：[1]新乡市第一人民医院骨科,453003 [2]解放军总医院第一医学中心骨科 [3]哈尔滨医科大学附属肿瘤医院肿瘤内科

出　　处：《中华保健医学杂志》2025年第1期18-22,共5页Chinese Journal of Health Care and Medicine

基　　金：国家重点研发计划(2020YFC2007405);河南省医学科技攻关计划联合共建项目(LHGJ20210893)。

摘　　要：目的比较采用截骨导向器与常规胫骨高位楔形截骨术治疗膝内侧骨关节炎的临床疗效。方法选取2021年10月~2022年10月于解放军总医院行胫骨高位截骨术的103例膝内侧骨关节炎患者进行前瞻性研究,采用随机数表法将患者随机分为导向器辅助组(n=51,采用截骨导向器辅助胫骨高位截骨术)和对照组(n=52,采用传统手术方式进行术中截骨)。两组患者均术后随访至后1年。比较两组患者术前临床特征,包括年龄、性别、手术侧别、术前美国膝关节协会评分(KSS)、术前西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分。比较两组胫骨近端内侧角(MPTA)、术后下肢力线角度偏差、术中透视次数和手术时间,并统计分析两组患者不良反应发生率和再住院发生率。结果导向器辅助组患者的手术时间短于对照组患者,术中透视次数少于对照组患者,MPTA大于对照组患者,术后下肢力线角度偏差小于对照组患者[(63.05±15.25)分vs.(71.41±13.05)分、(3.69±1.40)分vs.(8.65±1.60)分、(88.2±1.4)vs.(87.2±1.9)、(1.1±0.82)vs.(1.7±1.2)],差异均有统计学意义(t=-2.670、-16.630、2.660、-2.300,P<0.05)。导向器辅助组患者术后3和6个月的KSS评分均高于对照组患者[(73.8±11.5)分vs.(69.4±7.9)分、(77.56±7.9)分vs.(74.36±7.2)分],差异均有统计学意义(t=2.32,2.15,P<0.05)。导向器辅助组患者术后1和3个月WOMAC中的僵硬评分均低于对照组患者[(2.2±1.23)分vs.(2.7±1.36)分、(2.2±1.1)分vs.(2.7±1.3)分],差异均有统计学意义(t=-2.04、-2.04,P<0.05)。结论与传统手术相比,截骨导向器辅助胫骨高位截骨术的术中透视次数、手术时间更少,下肢力线角度偏差角度更小。使用截骨导向器能够减少术中辐射的暴露,提高膝关节手术的精确性,可以作为截骨矫形的一种重要辅助手段。Objective The purpose of this study was to compare the clinical efficacy of using a bone cutting guide with conventional high tibial osteotomy in the treatment of knee medial osteoarthritis.Methods This study included 103 patients who underwent high tibial osteotomy at our hospital,randomly divided into two groups:the guide-assisted group(51 patients)and the control group(52 patients).The guide-assisted group underwent high tibial osteotomy assisted by a bone cutting guide,while the control group underwent traditional surgery.Surgical time,intraoperative fluoroscopy frequency,medial proximal tibial angle(MPTA),postoperative mechanical axis deviation angle was compared.Knee Society Score(KSS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were used to evaluate knee joint function and pain before and after surgery.Adverse reaction rates and rehospitalization rates between the two groups were also statistically analyzed.Results The guide-assisted group showed significant advantages over the control group in terms of intraoperative fluoroscopy frequency(3.69±1.4 vs 8.65±1.6),surgical time(63.05±15.25 vs 71.41±13.05),postoperative MPTA(88.2±1.4 vs 87.2±1.9),and postoperative mechanical axis deviation angle(1.1±0.8 vs 1.6±1.2),(t=-16.63,-2.67,2.66,-2.30,P<0.05).Both groups were followed up for 1 year.In terms of WOMAC scores,the experimental group showed better stiffness scores at 1 month(2.2±1.23 vs 2.7±1.36)and 3 months(2.2±1.1 vs 2.7±1.30)postoperatively compared to the control group(t=-2.04,-2.04,P<0.05).In terms of KSS scores,at 3 months postoperatively(73.8±11.5 vs 69.4±7.9)and 6 months postoperatively(77.56±7.9 vs 74.36±7.2),the experimental group was superior to the control group(t=2.32,2.15,P<0.05).There was no significant difference between the two groups in the occurrence rate of adverse events and rehospitalization after surgery.Conclusion Our study results indicate that the use of a bone cutting guide in assisted surgery significantly reduces intraoperative fluorosc

关 键 词：截骨导向器 胫骨高位截骨 膝骨关节炎 

分 类 号：R68[医药卫生—骨科学]