内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎

目的 比较两种胫骨高位截骨术的手术方法和临床结果.方法 膝内翻骨关节炎患者68例,其中37例采用外侧闭合胫骨高位截骨术(closed wedge high tibial osteotomy,CWO),31例采用内侧撑开胫骨高位截骨术(open wedge high tibial osteotomy,OWO).术后摄X线片测量胫骨平台后倾角、髌骨高度、胫骨股骨角、内侧胫股关节间隙宽度,并行HSS和Lysholm功能评分.结果 患者均随访24个月以上.术前、术后两组HSS和Lysholm评分差异均无统计学意义.(1)CWO组术前胫骨平台后倾角8.57°±1.63°、术后5.03°±1.24°,OWO组术前8.71°±1.66°、术后10.10°±1.30°,差异均有统计学意义.(2)CWO组术前Insall-Salvati指数0.880±0.053、术后0.820±0.049,差异有统计学意义;OWO组术前0.892±0.043、术后0.897±0.042,差异无统计学意义.CWO组术前Blackburne-Peel指数0.804±0.040、术后0.801±0.339,差异无统计学意义;OWO组术前0.815±0.039、术后0.766±0.037,差异有统计学意义.(3)术后CWO组外翻8.06°±2.75°,OWO组外翻8.65°±1.46°.结论 膝内翻骨关节炎的内侧撑开和外侧闭合胫骨高位截骨术有相似的手术效果,内侧撑开截骨术截骨角度更加准确.外侧闭合胫骨高位截骨术后可出现胫骨后倾减小和髌韧带短缩,内侧撑开截骨术后易出现胫骨后倾增加和髌骨至关节线距离减小.

Comparison of lateral closing and medial opening-wedge technique for high tibial osteotomy in varus knee

Objective To compare the surgical methods and clinical results of two kinds of high tibial osteotomy in varus knee. Methods A retrospective analysis was preformed on 68 cases with knee varus who underwent high tibial osteotomy, including 37 cases with closing wedge high tibial osteotomy (CWO) and 31 cases with opening wedge high tibial osteotomy (OWO). Tibial slope was measured using post-operative X-ray film and HSS and Lysholm scores were evaluated. Results All patient were followed up for more than 24 months. There were no statistical differences in pre- and postoperative HSS and Lysholm scores between groups, respectively. 1) The pre- and postoperative tibial slope in the CWO were 8.57°±1.63° and 5.03°±1.24°, respectively, and in the OWO group were 8.71°±1.66° and 10.10°±1.30°, respectively, and sta-tistical difference was found within each group. 2) The pre- and postoperative Insall-Salvati index in the CWO were 0.880±0.053 and 0.820±0.049, respectively, with statistical difference; and in the OWO group were 0.892±0.043 and 0.897±0.042, respectively, without statistical difference. Blackbume-Peel index was 0.804±0.040 preoperative and 0.801±0.339 postoperatively in CWO, without statistical difference; 0.815± 0.039 preoperatively and 0.766±0.037 postoperatively in the OWO, with statistical difference. 3) Postopera-tively all patients showed knee valgus. The valgus angle was 8.65°±1.46° in the OWO and 8.06°±2.75° in CWO. Conclusion There was similar clinical results for both osteotomy techniques, with a more accurate angle in the OWO. Tibial slope decreasing and patellar tendon shortening were observed after CWO, however, OWO can cause the increase of tibial slope and the decrease between the patella and tibiofemoral joint line.