胫骨高位截骨治疗膝关节单间室骨性关节炎进展

本文对内侧张开式楔形胫骨高位截骨(HTO)技术治疗膝关节单间室骨性关节炎国外应用进展进行综述。多年来,HTO技术一直被认为是治疗膝关节单间室骨性关节炎很有价值的手术方法。正确的术前评估和手术的精确性,对手术的成功较重要,患者相对年轻、术前关节活动好、单髁性骨性关节炎且伴有膝内翻畸形是最佳的手术适应证。植骨材料的选择包括:自体髂骨块、同种骨和骨替代材料等,但是应用自体髂骨块,仍是当今临床应用的金标准。术中截骨操作时,应用C形臂X线机监测很重要,以防截骨方向偏斜,截骨位置理想后再行植骨。研究资料表明:负重线向外移至胫骨平台宽度的62%～66%处时,治疗效果较满意。患者选择适当、截骨角度准确和不发生手术并发症是手术成功的重要因素。

Advance of high tibial osteotomy for the treatment of unicompartmental osteoarthritis of the knee

This article reviews overseas progress of high tibial osteotomy(HTO) with medial opening wedge osteotomy for the treatment of unicompartmental osteoarthritis of the knee.HTO has been considered a valuable option in the surgical management or knee osteoarthritis.Accurate preoperative assessment and technical precision are essential to achieving satisfactory outcomes.High tibial osteotomy is appropriated for relative young,active patients who have primary degenerative arthritis involving a single compartment with a varus deformity of the knee.Graft choices include autograft,allograft,or bone substitutes.Each option has its own advantages and disadvantages,and although iliac crest autograft probablely remains the current gold standard.While performing the osteotomy,it is important to regularly check progress with a fluoroscope to ensure the appropriate depth and direction of the cut.Once the desired correction has been achieved and the defect is grafted using the preferred bone graft.The researchers have examined this in relation to the site of the weight-bearing line,with best results seen when this passes through the lateral plateau at 62% to 66% of the width or the plateau of the tibial.The selection of the appropriate patient and the attainment of a precise correction without complications are critical to the success.