综合手术治疗膝关节骨性关节炎合并膝内翻

目的 为使膝关节骨性关节炎合并膝内翻的年轻患者延缓行全膝关节置换,探讨股骨内髁马赛克植骨、髌骨成形并胫骨高位截骨综合手术治疗膝关节骨性关节炎合并膝内翻的临床疗效.方法 2004年6月-2006 年2月,对8例10膝骨性关节炎合并膝内翻患者行综合手术治疗.其中男2例3膝,女6例7膝;年龄42～56岁.左膝3例,右膝3例,双膝2例.患者均表现为行走或站久后疼痛.X 线片示股胫关节及髌骨边缘骨质增生,以内侧为重,髌股关节间隙变窄或消失,膝关节内侧间隙明显变窄.股胫角185～200°,平均 190°;HSS 膝关节评分为55～75分,平均60分.膝痛1～12年,平均5年. 结果 术后切口均Ⅰ期愈合,无早期并发症发生.患者均获随访7～24个月,平均15个月.患者截骨部位均于8～11 周达临床愈合,平均9周.股胫角矫正15～30°,平均 20°,基本恢复正常负重力线,膝关节外翻角 10°.术后关节活动度为 100～120°,较术前增加 5～20°,平均增加 10°.X 线片示膝关节内翻畸形基本纠正,截骨处无移位,内固定无松动、断裂.术后6个月HSS膝关节评分75～88分,平均80分. 结论 股骨内髁马赛克植骨使关节软骨得到一定程度的修复重建,髌骨成形有效解决膝前区疼痛,胫骨高位截骨矫正异常负重力线,三者结合,疗效肯定.

COMBINED OPERATION IN TREATMENT OF OSTEOARTHRITIS OF KNEE WITH GENU VARUM

OBJECTIVE: To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty, to observe the clinical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy in the treatment of osteoarthritis of knee with varum. METHODS: From June 2004 to February 2006, 8 patients with osteoarthritis of knee with varum (10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellar-plasty and hightibial osteotomy. There were 2 males with3 knees, and 6 females with7 knees,withan average age of 50 years (42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients had knee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibial joint, especially in the medial. The gap between patella and femur narrowed or disappeared, especially in the medial femurtibial joint. The femoral tibial angel (FTA) was 185-200 degrees (mean 190 degrees). The HSS score of knee was 55-75 (mean 60). The history of knee ache was 1-12 years (mean 5 years). RESULTS: All patients were followed up for 7-24 months (mean 15 months). All the incisions healed by first intention,no early complication occurred. The clinical bone healing time was 8-11 weeks (mean 9 weeks). Rectification of FTA was 15-30 degrees (mean 20 degrees). Normal weight-loading alignment was recovered. The valgus angle of knee was 10 degrees. The range of motion of knee was 100-120 degrees after operation, increasing by 5-20 degrees (mean 10 degrees) when compared with preoperation. The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakage occurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. CONCLUSION: Mosaic-plasty of femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can relieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading alignment. The curative effect is good with the combined methods.