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...     

胫骨高位截骨术治疗膝关节骨性关节炎66例报道

选取我院2006年1月～2013年12月收治的66例膝关节骨性关节炎患者,均行胫骨高位截骨术,对其临床疗效进行分析。结果 66例患者术前评分33～75（53.6±10.9）分,术后42～97（73.2±16.8）分,两者比较,差异具有统计学意义（P〈0.05）。胫骨高位截骨术治疗治疗膝关节骨性关节炎临床效果明显。     

膝关节清理加胫骨高位截骨治疗内翻型膝骨性关节炎46例分析

目的 介绍膝关节清理加胫骨高位截骨术治疗内翻型膝骨性关节炎的方法及较好的治疗效果。方法 ①切除髌股关节以及股胫关节边缘增生的骨赘；清除关节游离体及变性并即将脱落软骨面；切除变性滑膜。②在胫骨外侧，胫骨平台关节面下作楔型截骨，并用自制“U”型钉内固定。结果 46例病人，经随访1-3．5年，优良率占91．3％，效果满意，无加重影响功能的并发症。结论 膝关节清理加胫骨高位截骨术为治疗膝骨性关节炎可行的外科治疗方法，截骨部位愈合良好，费用低廉，是基层医院治疗内翻型膝关节关节炎的有效方法．     

膝关节骨性关节炎患者胫骨高位截骨术后恢复运动的影响因素

目的探讨膝关节骨性关节炎患者胫骨高位截骨术后恢复运动的影响因素。方法选择2015年5月至2018年5月在北京京煤集团总医院因膝关节骨性关节炎做胫骨高位截骨术治疗的73例患者作为研究对象,根据术后恢复运动运动情况,分为观察组54例(术后恢复运动)和对照组19例(术后未恢复运动),采用单因素及多因素logistic回归分析用于确定术后恢复运动的影响因素。结果单因素分析结果显示美国麻醉师协会(American society of anesthesiologists,ASA)分级、肥胖(体重指数≥28kg/m2)、年龄>60岁、术前参加体育运动及手术方式均是术后恢复运动的影响因素(P<0.05)。多因素logistic分析结果显示ASA分级较高、肥胖与年龄>60岁对患者术后恢复运动不利(P<0.05),而术前参加体育运动对患者术后恢复运动有利(P<0.05)。结论ASA分级较高、肥胖、年龄>60岁对患者胫骨高位截骨术后恢复运动不利,而术前参加体育运动对患者胫骨高位截骨术后恢复运动有利。     

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。     

探讨胫骨高位截骨术治疗早期膝关节骨性关节炎的临床应用价值

目的 探析在早期膝关节骨性关节炎患者治疗过程中运用胫骨高位截骨术的临床价值.方法 选取2020年8月至2021年7月济南市莱芜人民医院收治的90例早期膝关节骨性关节炎患者,采用随机数字表法将其分为对照组(45例)与试验组(45例).对照组患者接受关节置换术治疗方式,试验组患者接受胫骨高位截骨术治疗方式.比较两组患者治疗...     

胫骨高位截骨治疗膝关节骨性关节炎（附19例分析）

一般资料1982年1月～1991年1月对19例、22膝膝关节骨性关节炎，采用胫骨高位截骨、生物力线测定，手术后住院治疗，门诊复查，长期随访观察，疗效肯定，报告如下：本组中男6例，女13例，年龄最大66岁，最小40岁，平均50岁；双膝内翻5例，单侧内翻14例，二例同时行髌股关节再造手术，骨膜移植手术，术后全部随访，最长4年，最短10个月，平均3年6个月。     

胫骨外侧闭合截骨术治疗膝内翻1例并文献回顾

江苏省中医院应用胫骨外侧闭合楔形截骨(lateral closing wedge high tibial osteotomy,LCWHTO)治疗1例膝内翻畸形患者,术后功能恢复良好,现报道如下. 1临床资料 患者,女,51岁,因"左膝疼痛伴活动不利两年余"入院,40年前因左侧胫骨骨髓炎于当地医院行"胫骨开窗引流+死骨去...     

胫骨高位外展截骨T形钢板内固定治疗退行性膝内翻

目的探讨退行性膝内翻治疗方法。方法对27例退行性膝内翻患者采用胫骨高位外展截骨T形钢板内固定治疗。结果所有病例经28~48个月,平均37个月随访,疼痛缓解,截骨全部愈合。结论胫骨高位外展截骨T形钢板内固定治疗退行性膝内翻方法简单,疗效可靠。     

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。     

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...     

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.     

腓骨截骨联合关节镜微骨折术对膝关节骨性关节炎患者关节功能及生活质量的影响

目的研究膝关节骨性关节炎治疗中腓骨截骨联合关节镜微骨折术的应用效果及对患者关节功能及生活质量的影响。方法采用回顾性分析方法,研究对象为2015年1月至2020年1月湖南省中医药研究院附属医院收治入院的65例膝关节骨性关节炎患者,根据不同治疗方式分为两组。对照组(n=32)单用关节镜微骨折术治疗,研究组(n=33)联用腓骨截骨与关节镜微骨折术治疗。比较两组患者手术前后膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分变化与术后并发症(神经损伤、膝关节内黏连、切口感染)发生率。结果两组患者术前膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分比较,差异无统计学意义(P>0.05)。两组患者术后膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分均较术前明显改善,且研究组患者术后各项指标均较同期对照组改善更显著,差异均有统计学意义(P <0.05)。两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论膝关节骨性关节炎治疗中腓骨截骨联合关节镜微骨折术的应用效果显...     

聚焦超声辅助治疗对膝关节骨关节炎患者近期膝关节功能及炎性因子水平的影响

目的 分析聚焦超声波辅助治疗对膝关节骨关节炎患者近期膝关节功能及炎性因子水平的影响。方法 选取膝关节骨关节炎患者80例,根据随机数字表法分为常规组与研究组,每组各40例。常规组给予药物干预联合功能锻炼,研究组在常规组治疗的基础上加用聚焦超声波辅助治疗。两组患者均治疗4周。比较两组患者的膝关节功能、疼痛程度以及关节液白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、IL-6水平。结果 治疗2、4周后,研究组VAS评分均低于常规组(P＜0.05);治疗4周后,研究组关节僵硬、关节肿胀、关节压痛、运动时痛、休息时痛以及总分均低于常规组(P＜0.05);研究组膝关节屈曲度、伸直度以及屈伸弧度均高于常规组(P＜0.05);研究组关节液IL-1、TNF-α以及IL-6均低于常规组(P＜0.05)。结论 聚焦超声波辅助治疗改善了膝关节骨关节炎患者近期膝关节功能,减轻了疼痛程度,降低了炎性因子水平,值得临床重视。     

Effectiveness of bone substitute materials in opening wedge high tibial osteotomy: a systematic review and meta-analysis

BackgroundA meta-analysis of eligible studies was performed to evaluate the effectiveness of bone substitute materials (BSMs) in opening wedge high tibial osteotomy (OWHTO) for knee osteoarthritis.MethodsA systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive literature search was performed, and studies comparing BSM with bone graft (BG) and without bone graft (WG) were included. The Cochrane risk of bias tool (version 1.0) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool were used to assess the risk of bias for randomized controlled trials (RCTs) and non-randomized studies (NRSs), respectively. The outcomes measured were the osteotomy gap size, the occurrence rates of non-union and lateral hinge fractures, knee functional score, infection and the Visual Analogue Scale (VAS). The quality of evidences was evaluated by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system.ResultsFive RCTs and eight NRS including 769 participants were included in our meta-analysis. The BSM group had a larger osteotomy gap size than the control group (MD: 0.41 mm, 95% confidence interval (CI): [0.06, 0.76], p=.02, I²=0%), with a significant difference. No significant difference was found between BSM and control group in main analysis in terms of bone non-union, but with a higher non-union rate when BSM combined with long locking plate was used. No significant differences were found in other outcome measures except for VAS from NRS subgroup. The quality of evidence for outcomes was low.ConclusionsBSM combined with locking plate techniques offers a safe and efficient alternative option in OWHTO for osteotomy gap larger than 10 mm, but be aware of the possibility of bone non-union. Given the inherent heterogeneity and low quality of the included studies, future well-designed RCTs are essential to verify the findings.

KEY MESSAGE

• The treatment of the osteotomy gap is still controversial.
• BSM combined with a locking plate offers a safe and efficient alternative option for OWHTO with an over 10 mm of osteotomy gap over 10 mm.
• Due to the inherent heterogeneity and low quality of the included studies, the results should be cautiously interpreted in clinical practice.

     

人工全膝关节表面置换治疗膝关节骨性关节炎伴重度膝内翻畸形的临床效果

目的探究人工全膝关节表面置换(TKA)治疗膝关节骨性关节炎(KOA)伴重度膝内翻畸形的临床效果。方法根据治疗方式的不同将本院收治的60例KOA伴重度膝内翻畸形患者分为对照组(23例,胫骨高位截骨术)和观察组(37例,TKA)。比较两组的手术效果。结果术后1年,两组的ROM、BBS及Lysholm评分均高于术前,且观察组的ROM高于观察组(P<0.05)。术后1年,两组的SF-36各项评分均高于术前(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论TKA治疗KOA伴重度膝内翻畸形的临床效果显著,可提高ROM,且患者无需经历二次手术。     

辨证施膳联合本体感觉训练对胫骨高位截骨术后患者胃肠功能恢复及下肢功能的影响

目的 探讨辨证施膳联合本体感觉训练对胫骨高位截骨术后患者胃肠功能恢复及下肢功能的影响.方法 选取2015年4月至2020年4月收治的胫骨高位截骨术后患者70例,随机将其分为对照组和观察组,各35例,对照组实施常规护理,观察组则加以辨证施膳联合本体感觉训练,比较两组的干预效果.结果 观察组的肠鸣音恢复、首次排气及首次排便...     

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis

The Tampa Scale of Kinesiophobia (TSK) has been used for a decade and is a valuable tool in researching pain-related fear. A variety of different factor models exist, however, and there are inconsistencies as to which model to use. The purpose of the study was twofold: 1) to thoroughly review existing factor models and 2) to empirically evaluate the previously proposed factor models in a large sample with persistent musculoskeletal pain. Subjects included 578 of 711 (81%) consecutive patients (aged 18-65 years) with persistent musculoskeletal pain from three different orthopedic outpatient clinics. We reviewed all existing factor models and performed confirmatory factor analyses on the existing models. Our review identified 11 factor models of the TSK. The identified models were tested on a large Swedish sample. All models were rejected because of unacceptable goodness-of-fit statistics in that specific sample. This study supports the fact that TSK is a multidimensional construct. Rather than searching for new factor solutions, future research should be devoted to forming a consensus for the conceptual and operational definitions of the construct kinesiophobia and the application of the Tampa Scale for Kinesiophobia. Physiotherapists are encouraged to take part in building new theories.