胫骨高位截骨术的远期疗效

目的：了解胫骨高位截骨术治疗膝关节骨关节炎并内翻畸形的远期效果，方法；自１９８５年５月～１９９５年５月施行胫骨高位截骨术６７例（８７膝），其中３８例（４９膝）获得平均５年４个月的随诊。对其疗效进行评价，结果：术后１～５年组优良率为８７．６％，５年以上组优良率为７２％，结论：胫骨高位截骨术治疗膝关节炎并内翻畸形是有效的，它可延缓或免除关节置换术，手术确切重建及术后保持下肢正常力线是提高远期疗效的重要     

胫骨高位截骨术研究新进展

胫骨高位截骨术是治疗膝关节内侧骨关节炎的有效方法,目标是纠正下肢不正常的力线,以减缓膝关节的退行性改变.近年来,该技术不断完善,研究成果主要包括:扩大了适应证范围,如中老年患者;增加了可选择的截骨方式与固定方式,根据不同情况可采取闭合、开放或圆顶式截骨附加内固定或外固定;改良了手术技巧,如保持对侧皮质的完整性、经胫骨结节下方截骨等,以减少并发症;明确了评价依据和观测指标,胫股角能较好地反映下肢对线情况;提供了更多关于患者随访的报道,揭示胫骨高位截骨术能获得良好的满意率和长期效果.     

胫骨高位截骨术的临床观察

目的　探讨关节镜协助下胫骨高位楔形截骨方法治疗骨性关节炎的效果。方法　选择 11例膝关节内翻畸形 ,采用胫前外侧入路 ,胫骨结节上楔形截骨 ,矫正畸形 ,钢板内固定。测定术前、术后关节间隙距离、膝关节外翻角 (FTA)、Mikritz线 ,进行JOA评分。结果　术后患者均随访 6个月 ,JOA评分由术前平均6 8 4分± 11 9分提高到 78 9分± 14 3分 ;Mikritz线由术前 34 5 %提高到 5 1 4 % ;FTA术前 183° ,术后为179°。术后JOA评分、Mikritz线和FTA与术前比较差异均有显著性 (P <0 0 5 )。关节间隙距离术前、术后差异无显著性 (P >0 0 5 )。结论　关节镜协助下胫骨结节高位截骨钢板内固定治疗伴膝内翻的中老年膝关节骨性关节炎可以缓解患者疼痛。力学轴线转移到外侧是手术关键 ,使用一个切口完成胫骨和腓骨截骨     

内侧开放胫骨高位截骨术治疗膝内侧骨关节炎

目的 探讨内侧开放胫骨高位截骨术(HTO)治疗膝内侧骨关节炎的疗效.方法 采用HTO治疗17例膝内侧骨关节炎患者(17膝).比较手术前后疼痛VAS评分、HSS评分,测量膝关节下肢全长股胫角(FTA)和胫骨近端内侧角(MPTA)、膝关节活动度.结果 患者均获得随访,时间12～25个月.切口均一期愈合.开始负重时间3～4(...     

关节镜联合内侧开放楔形胫骨高位截骨术后的步态分析

目的 探讨关节镜联合内侧开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎的短期治疗效果及步态分析.方法 选择2018年5月-2019年6月接受关节镜联合内侧开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎的18例患者,所有患者膝关节OA分级在Ⅱ～Ⅲ,术前常规摄下肢负重位力线片,并测量胫骨近端内侧角(MPTA)、股骨远端...     

内侧张开胫骨高位截骨术中未植骨的预后研究

目的研究内侧张开胫骨高位截骨术中不植骨的术后骨预合情况。方法回顾性分析2008年1月至2012年1月内侧张开胫骨高位截骨术43例,分为A、B两组,A组术中植骨(骨移植或采用羟基磷灰石人工骨),B组未植骨,比较两组骨性愈合程度、愈合时间、完全负重时间及并发症情况等。结果两组各项临床指标无统计学差异,其中A组骨愈合时间(16.42±1.53)周,B组骨愈合时间(17.80±1.72)周(P=0.08)。随访期间未出现内固定失效、钢板松动断裂、感染等并发症。结论内侧张开胫骨高位截骨术中不植骨也可获得满意预后。     

胫骨高位截骨术后髌骨低位

目的探讨胫骨高位截骨术治疗膝关节内侧间室骨性关节炎后髌骨低位与胫骨近端关节面后倾角度改变之间的关系,并提出预防和控制髌骨低位的措施。方法41例(48膝)膝关节内侧间隙骨性关节炎患者,男30例(33膝),女11例(15膝);年龄45～56岁,平均52岁。所有病例均行胫骨外侧高位楔形截骨术。根据术前测量的截骨角度(内翻角+正常外翻角+过度矫形3°～5°),在槽刀和导向器等辅助下切除楔形骨块,用改良Giebel槽式钢板拉力螺钉内固定,术后不需外固定。测量48膝行胫骨高位截骨术患者术前及术后X线片的Insall-Salvati比值、胫骨近端关节面后倾角度、胫骨结节高度、患肢解剖轴线角度,并用χ2检验和直线回归分析进行统计学处理。检验时假定术后胫骨近端关节面后倾角度减小≥5°以及髌骨高度下降≥10%具有临床意义。结果术后胫骨近端关节面后倾角度比术前平均减小6.14°,Insall-Salvati比值术前、术后相对变化率为10.6%,胫骨结节高度比术前平均下降3.13mm。64.6%的病例胫骨近端关节面后倾角度减小≥5°。按Insall-Salvati比值结果,56.2%的病例髌骨高度相对下降率≥10%。胫骨近端关节面后倾角度的减小与髌骨高度的相对下降具有显著的统计学相关性。结论胫骨近端关节面后倾角度的减小与髌骨低位具有相关性,提示在施行胫骨高     

胫骨高位截骨术后矫形角度变化的分析

目的 调查随时间推移,内侧开放楔形胫骨高位截骨术(open-wedge high tibial osteotomy, OWHTO)术后矫形角度是否丢失,并确定哪些因素与其相关。方法 回顾性研究2018年5月至2020年10月期间于新疆医科大学附属中医医院进行OWHTO的患者,共纳入40例(45膝)患者,男15例,女25例;平均年龄为(55.4±11.86)岁。测量患者术前、术后、术后1年时的髋-膝-踝角(hip-knee-ankle angle, HKA)、胫骨近端内侧角(medial proximal tibial angle, MPTA)、关节线会聚角(joint line convergence angle, JLCA)、胫骨后倾角(posterior tibial slope, PTS)及Caton指数;比较患者术前、术后1年的西安大略和麦克马斯特大学骨关节炎指数(western Ontario and McMaster universities osteoarthritis index, WOMAC)和美国膝关节协会(American knee society, AKS)评分...     

Long-term outcome after high tibial osteotomy

Introduction The frequency of tibial osteotomy in the treatment of osteoarthritis of the knee has decreased due to the demanding surgical procedure and the rising number of total knee replacements (TKR). Only few data exist concerning survival rates after high tibial osteotomy (HTO) with a follow-up exceeding 10 years. We want to present long-term results with a follow-up of more than 18 years after operation. Materials and Methods Survival rates and the influence of age, gender and the mechanical axis were investigated in 134 lateral closing-wedge osteotomies in 111 patients. Results The survival rate was 94% after 5 years, 79.9% after10 years, 65.5% after 15 years, and 54.1% after 18 years. Age had a significant influence on the survival and gender and the mechanical axis had no significant influence. Conclusion We conclude, that with a 54.1% survival after 18 years HTO is a useful facility to protract the implantation of a total knee prosthesis. An erratum to this article can be found at     

Total knee arthroplasty coincident with high tibial osteotomy

Established lower limb alignment and knee stability are the two main prognosis factors influencing good functional result and prosthesis life. During Total Knee Arthroplasty (TKA), correction of tibial extra-articular deformity cannot be achieved without ligament balancing. Excessive valgus deformity after a failed high tibial osteotomy (HTO) necessitates a much larger resection of bone from the medial tibial plateau resulting in a trapezoidal extension gap. In overcorrected valgus knee patients after failed HTO, meticulous preoperative planning is required to predict complementary procedures needed to achieve flexion-extension balance with optimal postoperative lower limb alignment. This article details the preoperative planning involved and the intraoperative technique used in such cases. We describe a planning methodology consisting of measuring medial and lateral distance between future femoral and tibial orthogonal resection lines, drawn on valgus and varus stress radiographs (arrows). If the medial distance (medial arrows) on the valgus stress radiographs is longer than the lateral arrows on the varus stress radiographs, a lateral release will be necessary to achieve a rectangular extension gap during TKA procedure. However, the lateral release needed to compensate medial bone resection is limited. This limit must not exceed 10 millimeters (about 8 to 10° of valgus malunion). Over this limit, total knee arthroplasty plus corrective tibial osteotomy is one of the solutions. We prefer to insert prosthesis inside the “ligament box”; without any ligamentous release. The limb alignment is achieved with corrective tibial osteotomy. We propose and describe how to carry out TKA based on a rectangular extension gap, associated, in the same procedure, with a HTO to restore a neutral alignment of the leg.     

Mid-term results of total knee arthroplasty after high tibial osteotomy

Background The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis. Materials and methods Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were compared with a matched group who underwent primary TKA. The knees were evaluated preoperatively and postoperatively according to the scoring systems of the Knee Society and Hospital for Special Surgery (HSS). The anteroposterior tibiofemoral alignment, the Insall–Salvati patellar position ratio, range-of-motion and the location of the lateral joint line, were also recorded. The patients were reviewed with a mean follow-up of 4.5 years after TKA. Results The preoperative and postoperative knee scores had no statistically significant differences between the two groups. So was the case with the intraoperative releases, blood loss, thromboembolic or neurologic complications and infection rates in either group. Access to perform the arthroplasty was reportedly more difficult and took an average of 25 min longer. A significant difference (p < 0.05) was detected in terms of impingement of the tibial stem on the lateral tibial cortex, patellar subluxation and patella baja between the two groups but this did not have any influence on the outcome of the prosthesis. Knee alignment and stability so as range of motion (ROM) measurements were also found with no statistical significance. Conclusion Although we did manage to detect statistically significant differences mainly in radiographic results between the two groups, this situation did not appear to influence the clinical outcome of the patients, however. The fact that most of the patients had good or excellent results at an average follow-up of 4.5 years suggests that HTO does not have a significant negative effect on later TKA.     

High tibial osteotomy for varus gonarthrosis: a 10- to 24-year follow-up study

From January 1976 to December 1990, 66 high tibial osteotomies for medial gonarthrosis were performed in 59 patients. Thirty knees of 26 patients (18 women and 8 men) were reviewed after a mean follow-up period of 15.3 years (range, 10–24 years). The mean age of these 26 patients was 59 years at the time of operation and 75.5 years at the latest follow-up. The average femoro-tibial angle changed, from 187° before surgery to 170° after surgery, and to 174° at the latest follow-up. Progression of osteoarthritic changes was observed in 87% for the medial and in 90% for the lateral compartment of the knee. Clinical results, assessed according to the Japanese Orthopaedic Association (JOA) knee score, showed improvement with a score of 65 points before surgery, and a score of 81 points at the latest follow-up. The overall clinical results were satisfactory for 60% of the knees. The results of this long-term follow-up study show that high tibial osteotomy for medial compartment osteoarthritis can be effective for as long as 15 years. Received: January 24, 2001 / Accepted: July 7, 2001     

胫骨高位截骨术后二次镜下探查软骨修复情况

目的:评估胫骨高位截骨术后膝关节内软骨修复情况。方法:选取2017年9月至2019年9月行胫骨高位截骨术,并在取内固定时再次镜下探查患者11例;其中男2例,女9例,年龄55～64岁。手术前后取内固定时留取内外间室图片并采用国际软骨修复协会软骨损伤分级系统(International Cartilage Repair Society grading systerm,ICRS)评估内外侧股骨髁与胫骨平台软骨损伤程度,采用美国西安大略与麦克马斯特大学骨关节炎指数评分(the Westrn Ontarioand Mcmaster Universities osteoarthritis index,WOMAC)与下肢力线比率(weight bearing line,WBL)评估临床效果与力线矫正情况。结果:11例患者均获得随访,时间12～22个月;所有患者的内侧股骨髁与胫骨平台损伤软骨得到不同程度的修复,WOMAC评分总分由术前的102～127分改善至41～52分,下肢力线比率由术前的17%～34%矫正至58%～64%;所有切口Ⅰ期愈合,术中及术后无内固定断裂、感染等并发症发生。结论:经胫骨高位截骨术矫正下肢力线,可以改善膝关节疼痛与功能障碍,并且损伤的内侧间室软骨可被不同程度修复。     

The high tibial osteotomy,open versus closed wedge,a comparison of methods in 108 patients

Introduction: One hundred and eight patients with varus gonarthrosis were treated with high tibial osteotomy (HTO) in 2001. Fifty one patients received an open wedge osteotomy by using the ‘Puddu’ plate and 57 patients received a Coventry-type closing wedge osteotomy. For both groups the follow-up examination period was 22.5 months (253–1009 days). Material and Methods: To evaluate the study, radiological and subjective criteria as well as the Lysholm and the Tegner Activity Score were used. Altogether 84 % of the patients were included in the follow-up examination study. Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment. Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.     

Recovery of muscle strength after high tibial osteotomy

 To assess muscle strength after high tibial osteotomy (HTO) using percutaneous drilling, we prospectively evaluated the isometric and isokinetic muscle torque of the thigh before operation and after operation over time. We evaluated 27 joints of 26 patients with a mean age of 66 years. The muscle torque/weight ratio was seen to decrease, and the hamstrings/quadriceps (H/Q) ratio increased at 3 months after HTO; both ratios showed no significant difference at 6 months. Improved muscle strength appeared at isometric extensor of 50°, not 80°, and at slow isokinetic speeds of 30°/s, not 90°/s. There was no significant difference in terms of the age of patients regarding the recovery of muscle strength. We also compared patients with a varus angle of ≥5° and those with a varus angle <5° before the operation. In terms of extension, the group with varus angles <5° showed a greater postoperative increase in isometric torque at 80° flexion of the knee and isokinetic torque at 90°/s than did the group with varus angles of ≥5°. Received: July 5, 2002 / Accepted: November 11, 2002 Offprint requests to: T. Kawazoe     

胫骨高位截骨手术并发症23例次分析

[目的] 探讨胫骨高位截骨手术并发症的发生情况，并提出预防和治疗措施。[方法]2000年1月～2004年10月采用胫骨高位截骨术治疗膝骨关节炎合并内翻畸形患者126人，21人发生手术并发症，男4例，女17例；年龄48～64岁，平均61岁。术前拍摄站立膝关节正位X线片，测量股骨一胫骨角，计算截骨角度，采用外侧闭合胫骨高位截骨术矫正膝内翻畸形。[结果] 术后随访6～12个月，平均7．5个月。共21名患者发生各类并发症23例次．发生率为16．7％。其中发生胫骨骨折4例，腓总神经麻痹3例，出现深静脉血栓形成5例，膝内翻复发病例6例，内固定失败4例（其中2例合并膝内翻复发），感染1例。[结论] 降低胫骨高位截骨手术并发症需要术者熟悉局部解剖和精确的术前设计，提高手术技巧及完善的围手术期护理。