开放胫骨高位楔形截骨术治疗膝关节内翻畸形

目的 评价双平面开放胫骨高位楔形截骨治疗成人膝关节内翻畸形的手术效果.方法 回顾性分析2001年6月至2008年7月存在膝关节内侧单间室退行性改变伴内翻畸形且进行双平面开放胫骨高位楔形截骨术治疗的12例患者的一般资料.术前膝内翻畸形5.0°～19.0°,平均11.5°;膝关节屈伸活动度大于90°;不伴有其他关节间室病变;1例伴有外侧副韧带及前交叉韧带断裂,行韧带重建手术后二期进行开放截骨矫形术.术前膝关节症状以内侧间室疼痛为主.手术前后测量患者关节活动度的大小,并对患者进行Lysholm评分.术后对患者进行主观满意度调查.结果 12例患者术后平均随访时间32.5个月.截骨处至术后12～16周均获得骨性愈合.矫正角度5.5°～18.0°,平均9.5°.在随访期间内X线检查下肢力线维持在术后水平,内外侧间室及髌股间室均未发现明显退变进展.手术总体效果优良率为83.3%,Lysholm评分、内翻角度变化在手术前后均有统计学显著性差异.结论 双平面开放胫骨高位楔形截骨术对中青年膝关节内翻畸形伴单间室退行性改变有良好的早、中期效果.

The efficacy of open-wedge high tibial osteotomy for varus knee

Objective To introduce the biplanar opening high tibial osteotomy with rigid fixation for adult varus knee. Methods Twelve patients with varus knee and degeneration of medial compartment received the biplanar opening high tibial osteotomy between June 2001 and July 2008. The pre-operative deformity was about 11.5° without osteoarthritis changes in other compartments. The average range of motion was more than 90°. One of the patients had ruptures of LCL and ACL, who received osteotomy after reconstruction of the ligaments. The main symptom before the operation was pain in medial compartment. The range of motion, Lysholm score and subjective satisfactory examinations were assessed before and after the osteotomy. Results All of the osteotomy sites were healed at twelve to sixteen weeks after operation. No complications such as plate broken or injury of nerve or blood vessel had occurred. The mean correct angle was 9. 5°. No degenerative changes had developed in other compartments of the knee. The mechanical axis of the lower extremities was maintained during the follow-up. The overall satisfactory rate was 83.3%.Statistically significant changes exist in the Lysholm score and varus degree. Conclusion The open-wedge high tibial osteotomy is suitable for the symptomatic genu varum in younger patients with good short-term and mid-term results.