胫骨高位外翻截骨、关节镜清理联合富血小板血浆治疗膝关节骨关节炎

目的探讨胫骨高位外翻截骨、关节镜清理联合富血小板血浆关节腔注射治疗膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻的可行性及疗效。方法对2011年4月至2013年7月在内蒙古自治区国际蒙医医院骨科就诊的膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻患者26例(31膝),其中男4例,女22例,行胫骨高位外翻截骨植骨术矫正膝内翻畸形,辅以关节镜关节清理术,术后自体富血小板血浆关节腔注射。观察截骨部位愈合时间,评估疗效优良率,记录治疗后72 h、6周、12周、24周VAS评分、KSS评分、HSS评分及FTA变化,采用重复测量方差分析进行分析;术后12周、24周MRICRS分级变化情况用pearson卡方检验。术后随访2~5年,平均4.7年。结果术后截骨部位临床愈合时间为(12.76±0.98)周,无感染及不愈合。疗效优26膝(83.87%),良4膝(12.90%),可1膝(3.33%),差0膝,优良率为96.77%。治疗前VAS评分(6.8±0.9)分,治疗后72 h、6周、12周、24周分别为(1.0±0.3)分、(0.4±0.02)分、(0.2±0.05)分、(0.2±0.01)分,与治疗前比较差异有统计学意义(P<0.05);HSS评分治疗前(43.1±3.4)分,治疗后分别为(79.9±2.4)分、(89.6±1.8)分、(93.1±2.2)分、(93.2±2.1)分,与术前比较差异有统计学意义(P<0.05);KSS临床评分和KSS功能评分治疗前分别为(36.8±4.1)分、(33.7±1.9)分,治疗后分别为(64.7±5.4)分、(72.4±4.4)分、(85.2±7.1)分、(88.7±5.5)分和(67.3±6.6)分、(75.2±5.3)分、(85.5±6.9)分、(89.1±6.1)分,与治疗前比较差异有统计学意义(P<0.05);FTA治疗前为184.9°±4.6°,术后分别为171.6°±3.1°、171.4°±2.7°、171.4°±2.3°、171.1°±1.9°,与治疗前比较差异有统计学意义(P<0.01)。治疗前关节软骨ICRS分级Ⅱ级19膝(59.37%)、Ⅲ级12膝(40.63%)。治疗12周后Ⅰ级25膝(80.65%)、Ⅱ级6膝(19.35%),治疗24周后Ⅰ级29膝(93.55%)、Ⅱ级2膝(6.45%),软骨修复效果显著(P<0.01)。结论胫骨高位外翻截骨、关节镜清理联合富血小板血浆关节腔注射疗法是治疗膝关节骨关节炎伴胫骨内翻畸形导致的轻、中度膝内翻安全有效的方法。     

胫骨高位截骨术治疗膝内翻骨性关节炎临床研究

目的评价胫骨高位截骨术在膝关节骨性关节炎中的临床疗效。方法选取2017年6月至2019年1月在该科住院的膝关节骨性关节炎患者共34例患者作为研究对象,均采用胫骨高位截骨术治疗,记录截骨手术并发症、愈合时间,采用胫骨近端内侧角(MPTA)、视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)评估临床疗效。结果所有患者获得了6~24个月随访,术后3~4个月截骨处达到骨性愈合,无伤口感染及骨不愈合,术前与术后3个月MPTA、VAS评分及HSS评分比较,差异有统计学意义(P<0.05),患者术后临床症状及下肢力线均较术前明显改善。结论掌握好适应证,采用胫骨高位截骨术可有效治疗膝内翻骨性关节炎。     

胫骨高位截骨结合关节镜治疗膝内侧骨关节炎

目的探讨胫骨高位截骨结合关节镜治疗膝内侧骨关节炎的疗效。方法选择膝内侧骨关节炎病人共38例,采用胫骨高位截骨结合关节镜治疗,并采用Tomofix内固定的方法。病人均随访3年以上,通过HSS膝关节功能评分、股骨胫骨角(FTA)及胫骨近端外侧解剖角(aLPTA)分析治疗效果。结果术后1年病人HSS膝关节功能评分(84.5±5.7分)显著高于术前(68.3±3.8分),在术后3年随访时,HSS膝关节功能评分(79.6±4.8分)较术后1年显著下降,但仍显著高于术前。术后1年病人FTA(173.52±1.09°)、a LPTA(88.01±1.09°)测量结果显著低于术前(184.36±1.21°,95.34±0.78°),在术后3年随访时,FTA与aLPTA测量结果有所上升(174.42±0.98°,89.15±0.98°),但仍显著低于术前。结论胫骨高位截骨结合关节镜治疗膝内侧骨关节炎中期矫形效果满意,无明显并发症发生,值得临床推广应用。     

全膝关节置换术治疗膝关节骨性关节炎合并屈曲内翻畸形疗效观察

目的:探讨人工全膝关节置换术治疗严重膝关节骨性关节炎合并屈曲内翻畸形的近期疗效。方法:46例(59膝)严重膝关节骨性关节炎合并屈曲内翻畸形患者,均行人工全膝关节置换术治疗。术后随访并根据KSS评分系统评价临床效果。结果:46例患者均获得随访,随访时间1~4 a,平均18个月。疼痛评分由术前8.6分提高至29.6分,KSS评分由术前39.6分提高至91.2分,优54膝(91.5%),良3膝(5.1%),可2膝(3.4%),优良率96.6%。结论:人工全膝关节置换术治疗严重膝关节骨性关节炎时,术中合理的截骨与软组织平衡可使明显畸形的膝关节在术后获得良好的畸形矫正和功能恢复。     

全膝关节置换术治疗膝关节骨性关节炎合并屈曲内翻畸形疗效观察

目的:探讨人工全膝关节置换术治疗严重膝关节骨性关节炎合并屈曲内翻畸形的近期疗效.方法:46例(59膝)严重膝关节骨性关节炎合并屈曲内翻畸形患者,均行人工全膝关节置换术治疗.术后随访并根据KSS评分系统评价临床效果.结果:46例患者均获得随访,随访时间1～4 a,平均18个月.疼痛评分由术前8.6分提高至29.6分,KSS评分由术前39.6分提高至91.2分,优54膝(91.5%),良3膝(5.1%),可2膝(3.4%),优良率96.6%.结论:人工全膝关节置换术治疗严重膝关节骨性关节炎时,术中合理的截骨与软组织平衡可使明显畸形的膝关节在术后获得良好的畸形矫正和功能恢复.     

腓骨近端截骨结合关节腔注射几丁糖治疗膝关节骨性关节炎临床效果分析

目的探讨腓骨近端截骨结合关节腔注射几丁糖治疗膝关节骨性关节炎(KOA)的临床效果。方法选取收治的膝骨关节炎老年患者100例,随机分为对照组(腓骨近端截骨术)与观察组(腓骨近端截骨术联合关节腔注射几丁糖)各50例。结果随访6个月,比较两组临床疗效、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、疼痛视觉模拟评分(VAS)、膝关节功能(KSS)评分及白细胞介素1β(IL-1β)、一氧化氮(NO)水平。观察组临床总有效率高于对照组(P<0.05);观察组WOMAC评分、VAS评分低于对照组,而KSS评分高于对照组(P<0.05);观察组IL-1β、NO水平低于对照组(P<0.05)。结论 KOA采用腓骨近端截骨结合关节腔注射几丁糖治疗可提高疗效,改善膝关节功能,缓解病程进展。     

腓骨近端截骨术对内翻型膝关节骨关节炎患者膝关节活动度及并发症的影响

目的研究腓骨近端截骨术和全膝关节置换术(TKA)治疗内翻型膝关节骨关节炎(KOA)的疗效及并发症。方法选取我院接诊的内翻型KOA患者126例(126膝),按随机数字表法分为截骨组和TKA组各63例(63膝),分别采用腓骨近端截骨术和TKA手术进行治疗,观察两组视觉模拟评分(VAS)、内翻角、膝关节活动度、膝关节功能评分(HSS)、生活质量、血清指标及并发症情况。结果截骨组手术时间、术中出血量、首次下床活动时间和住院时间均低于TKA组(P<0.05);两组治疗后3个月时VAS评分、股骨力线、下肢力线和关节间隙夹角和内翻角均降低,膝关节活动度、HSS评分和SF-36评分均升高(P<0.05),但两组间各指标比较差异无统计学意义(P>0.05);截骨组术后并发症发生率低于TKA组(P<0.05)。结论腓骨近端截骨术和TKA治疗内翻型KOA均具有确切效果,其中腓骨近端截骨术创伤更小,有利于减少术后并发症并促进患者康复,较TKA具有明显微创优势。     

不同手术方式治疗膝关节内侧间室骨关节炎的效果

目的分析不同手术方式在膝关节内侧间室骨关节炎中的应用效果。方法选取膝关节内侧间室骨关节炎患者127例,根据手术方式不同分为A组43例(行腓骨近端截骨术)、B组43例(行单髁关节置换术,UKA)和C组41例(行全膝关节置换术,TKA)。观察三组手术相关情况,术前和末次随访时胫骨角、膝关节疼痛、膝关节功能及活动度的变化及并发症情况。结果 A组手术时间、住院时间及术后恢复时间较B、C组明显缩短,术中出血量及医疗费用明显减少(P0.05或P0.01)。三组术前及末次随访时胫骨角、关节活动度、VAS、HSS及KSS评分比较均差异无统计学意义(P0.05),但末次随访时胫骨角、关节活动度、VAS、HSS及KSS评分均较术前明显改善(P0.05或P0.01)。除A组2例发生腓浅神经损伤症状外,其余均未见感染、髌股关节疼痛、假体位置不良等并发症发生。结论腓骨近端截骨术治疗膝关节内侧间室骨关节炎具有创伤小、恢复快、费用低等优点,且可获得与UKA、TKA相似的近期疗效。     

关节镜联合胫骨高位截骨治疗膝内翻骨关节炎合并前交叉韧带损伤

目的探讨关节镜联合胫骨高位截骨治疗膝内翻骨关节炎合并前交叉韧带损伤的临床疗效。方法选择膝内翻骨关节炎合并前交叉韧带损伤的病人共42例,均行关节镜联合胫骨高位截骨治疗。观察随访术前和术后1年、3年膝关节HSS功能评分、Lysholm评分、股骨胫骨角(FTA)的变化。结果所有病人手术均顺利完成。术后1年与术后3年HSS膝关节功能评分和Lysholm评分显著高于术前,FTA测量结果显著低于术前,术后1年和术后3年的结果无统计学差异。结论关节镜联合胫骨高位截骨治疗膝内翻骨关节炎合并前交叉韧带损伤的疗效确切,值得临床推广。     

改良胫骨高位截骨术治疗膝关节骨性关节炎合并膝内翻31例分析

目的：探索改良胫骨近端前内侧小切口胫骨高位截骨术治疗膝关节骨性关节炎合并关节内翻畸形的可行性及疗效。方法：采用胫骨高位骨侧切口截骨，截骨面植骨，根据术前测量选用相应的矫形钢板内固定。结果：术后平均随访3．3a，参照Coventry疗效评定标准，优26膝，良13膝，中2膝，差1膝，优良率92．8％。结论：改良胫骨内侧高位截骨，手术创伤小，时间短，方法易于掌握，截骨部位愈合佳，疗效满意。     

关节镜下清理并半月板切除治疗合并膝骨关节炎的半月板损伤

目的探讨关节镜下清理并半月板切除治疗合并早、中期膝关节骨关节炎(KOA)的中、重度半月板损伤的疗效。方法选取2011年10月-2014年10月该科156例合并有早、中期KOA的中、重度半月板损伤患者,行关节镜下清理并半月板切除术。术前对所有患者行Lysholm膝关节功能评分,常规行膝关节正侧位、髌骨轴位、双下肢全长站立位X片和患膝磁共振成像(MRI)检查,明确KOA诊断和临床分期以及半月板损伤诊断和分级。所有患者均在全麻下行关节镜下关节清理并半月板切除术。术后积极行患肢康复训练,术后7~10天出院,出院后佩戴护膝负重行走。采用门诊复诊或电话方式对患者进行随访。结果所有患者均无围手术感染、化脓性关节炎等严重围手术期并发症;术后随访6~12个月,平均10.9个月。Lysholm膝关节功能评分术后(87.3±7.9)明显优于术前(67.5±4.9)(P0.05)。结论关节镜下清理并半月板切除治疗合并早、中期KOA的中、重度半月板损伤,创伤小、恢复快、近期疗效良好。     

3D打印个体化截骨导板辅助胫骨高位截骨术治疗内翻型膝骨关节炎精准性的临床疗效

目的:观察3D打印个体化截骨导板(patient-specific instrumentation, PSI)辅助胫骨高位截骨术(high tibial osteotomy, HTO)治疗内翻型膝骨关节炎的精准性。方法:2018年5月至2020年12月采用3D打印PSI辅助内侧开放胫骨高位截骨术治疗15例膝内翻畸形合并骨性关节炎患者,通过术前CT三维重建模拟规划截骨手术时的胫骨近端内侧角(medial proximal tibial angle, MPTA)、下肢负重线比率(weight bearing line, WBL)落点、撑开高度、胫骨后倾角(posterior tibial slope, PTS)、关节线交角(joint line convergence angle, JLCA),并与截骨术后实际测量值进行比较。结果:术前规划与术后测量的MPTA、WBL落点、撑开高度、PTS及JLCA之间差异均无统计学意义,一致性良好。所有患者伤口均Ⅰ期愈合,无并发症。结论:3D打印PSI辅助胫骨高位截骨术能够增加下肢力线矫正的精准性,降低PTS、JLCA等变化的风险,提高疗效。     

Extendierende und flektierende Tibiakopfosteotomien

Valgus high tibial osteotomy (HTO) for treatment of unicompartmental medial osteoarthritis of the knee is well established. Further indications for HTO are patients with lateral knee instability and varus malalignment. In addition to these corrections, which are carried out in the frontal plane of the knee, osteotomies can also be performed in the sagittal plane. High tibial flexion and extension osteotomies are used to increase or decrease the tibial slope of the patients, which aims to treat hyperextension or an extension deficit of the knee. A three-dimensional combination of an osteotomy both in the frontal (valgus) and the sagittal plane can be used to address complex pathologies such as medial osteoarthritis and posterior (increase of tibial slope) or anterior (decrease of tibial slope) knee instability. Patients demonstrating both symptomatic anterior knee instability with giving way and pivoting and medial joint line pain are treated with a valgus extension osteotomy combined with simultaneous arthroscopic ACL reconstruction.     

外侧盘状半月板成形术对早期骨关节炎的疗效观察*

目的探讨外侧盘状半月板(DLM)成形术对早期骨关节炎(OA)的影响。方法①治疗组:对30例32膝有症状的DLM患者行关节镜下DLM成形术;②对照组:对26例28膝有症状的DLM患者,行关节镜下DLM次全切术;③选取治疗前、治疗开始至第20周、治疗后2年3个时间点,观察两组的视觉模拟评分(VAS)、McMurray试验、X线(负重正位)股胫角(FTA)、膝关节磁共振成像(MRI)软骨损伤分级和Harris评分,对两组数据行不同时间点的组间及组内比较。结果治疗组Harris膝关节功能评分术前41～89(61.87±10.75)分,术后2年随访时79～96(88.43±3.99)分,术前和术后比较,差异有统计学意义(P 0.05)。对照组Harris膝关节功能评分术前50～86(61.67±8.47)分,术后2年随访时75～95(85.76±4.74)分,术前和术后比较,差异有统计学意义(P 0.05)。随访结束时,治疗组膝关节功能优于对照组,差异有统计学意义(P 0.05)。结论外侧DLM成形术能拯救更多有功能的残余物,对外侧DLM损伤患者的下肢力线改善作用更明显,在延缓膝关节软骨退变方面更有优势。     

Taylor空间外固定架联合胫骨高位截骨术对膝骨性关节炎并膝内翻患者膝关节功能的影响

目的探讨分析Taylor空间外固定架联合胫骨高位截骨术(HTO)在膝骨性关节炎并膝内翻患者中的应用。方法回顾性选取2018年3月至2020年12月唐山市开滦总医院接受治疗的40例膝骨性关节炎并膝内翻患者,按照治疗方法不同分为2组,各20例。观察组患者采用Taylor外固定,对照组患者采用钢板内固定,2组均行HTO。观察记录2组患者术中出血量、手术时间,对比分析2组患者术前和术后12个月的胫股骨角、纽约特种外科医院(HSS)评分和美国膝关节协会评分(KSS)评分情况。记录比较2组患者不良反应发生情况。结果观察组患者的术中出血量和手术时间分别为(129.33±8.97) mL、(58.27±4.31) min,均明显少于对照组[(162.36±16.34) mL、(73.32±5.42)min],差异有统计学意义(P <0.05)。术后12个月2组患者的胫股骨角较术前显著降低,HSS、KSS评分均较术前显著升高,且观察组患者的胫股骨角(168.3±0.5)°低于对照组[(178.6±1.9)°],HSS、KSS评分分别为(89.33±5.92)、(80.27±5.71)分,均高于对照组[(85.24±5.27)、(76.33±5.04)分],差异均有统计学意义(P <0.05)。2组患者术后均未见严重并发症。结论与钢板内固定相比,Taylor外固定架联合HTO更能有效改善膝骨性关节炎并膝内翻患者的膝关节功能,有着较好的临床疗效,值得临床推广应用。     

Patella kinematics and patello-femoral contact areas in patients with genu varum and mild osteoarthritis

BACKGROUND: Patients with genu varum of the knee and moderate to severe osteoarthritis often suffer from additional symptoms of the patello-femoral joint. These patients have a poor prognosis following high tibial osteotomy. It is unclear whether varus knees with only mild femoro-tibial osteoarthritis are also associated with alterations of patella biomechanics, and affect the prognosis of intended high tibial osteotomy. METHODS: Fifteen patients with genu varum and mild osteoarthritis and 15 healthy volunteers were assessed in an open MRI-scanner. 3D-GRE sequences of the knee were obtained in 0 degrees, 30 degrees and 90 degrees with and without activity of the extensor muscles. After segmentation of patella, femur, tibia and the adjacent cartilage, a patella-based local coordinate system was established. Femoral and tibial reference points allowed definition of the spatial position of the patella. Contact areas were defined by intersection of opposing cartilage volumes. FINDINGS: No significant differences in patella kinematics and patello-femoral contact areas could be found (P > 0.05) between varus knees with mild osteoarthritis and healthy knees either at different flexion angles or under extending muscle activity. INTERPRETATION: In knees with genu varum and mild medial osteoarthritis we could detect no alterations in patello-femoral kinematics. Since the alterations of patients with genu varum and mild osteoarthritis are restricted to the medial femoro-tibial joint high tibial osteotomy might be successful.     

开放楔形胫骨高位截骨术治疗膝关节内侧间室骨性关节炎对髌骨参数及关节功能的影响

目的 探讨开放楔形胫骨高位截骨术(OWHTO)治疗膝关节内侧间室骨性关节炎对髌骨参数及关节功能的影响.方法 回顾性分析2018年7月—2020年6月收治的膝关节内侧间室骨性关节炎98例的临床资料,按照术式分为研究组45例和对照组53例.研究组给予OWHTO治疗,对照组给予单髁置换术(UKA)治疗.比较两组手术前后膝关节...     

Effect of tibial re-alignment surgery on single leg standing balance in patients with knee osteoarthritis

Background

Standing balance is impaired in individuals with knee osteoarthritis and is associated with disease severity. The effects of surgical interventions on standing balance have received little attention. The purpose of the present study was to examine measures of balance during tests of single-limb standing before and after medial opening wedge high tibial osteotomy – a lower limb re-alignment procedure for those with varus alignment and knee osteoarthritis.

Methods

Standing balance was assessed in 49 individuals prior to and 12 months following medial opening wedge high tibial osteotomy. Participants performed three trials of single-limb balance lasting 10 s each while standing on a force platform. Anteroposterior and mediolateral coordinates of the centre of pressure were obtained from the force platform and used to calculate the total centre of pressure path length as well as the range and variability (standard deviation) of the anteroposterior and mediolateral coordinates.

Findings

Though all centre of pressure measures were lower following high tibial osteotomy, none reached statistical significance (P > 0.05) and effect sizes were small (d < 0.34). The largest mean improvement was 7.6% (95% confidence interval: −0.7–15.8%).

Interpretation

Results indicate that standing balance in individuals with knee osteoarthritis is not significantly different following high tibial osteotomy surgery. Standing balance in this patient population is a complex process not entirely dictated by disease symptoms or structural factors such as alignment.     

Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy

BackgroundRecurrent varus deformity and poor outcome sometimes occur following open-wedge high tibial osteotomy, but the mechanism remains unclear. The hypothesis of this study was that an excessively large medial proximal tibial angle with lateral joint surface inclination can worsen postoperative knee biomechanics.MethodsA computer-simulated knee model was validated based on a volunteer knee. Osteotomy models with medial proximal tibial angles ranging from 90° to 97° in 1° increments were developed. Varus alignment correction of the distal femur was performed in each model to maintain identical coronal alignment passing through a point 62.5% lateral to the tibial plateau. The peak tibiofemoral contact forces and knee kinematics were compared in each model during walking and squatting.FindingsAll the osteotomy models demonstrated higher peak contact forces on the lateral tibiofemoral joints than on the medial tibiofemoral joints during walking. However, larger medial proximal tibial angles caused excessive increases in medial tibiofemoral contact forces, and the dominant tibiofemoral contact forces shifted to the medial side. Increased medial proximal tibial angles also caused progressive medial collateral ligament tension in knee flexion, but partial medial collateral ligament release effectively reduced medial tibiofemoral contact forces. Models with large medial proximal tibial angles showed nonphysiological roll-forward of the lateral femoral condyle during squatting and no screw-home movement around knee extension.InterpretationExcessively large medial proximal tibial angles following open-wedge high tibial osteotomy resulted in increased medial tibiofemoral contact forces and abnormal knee kinematics during knee flexion due to medial joint line elevation and ligament imbalance.