应用新型槽式钢板固定的胫骨高位截骨术治疗膝关节骨性关节炎

目的探讨应用新型槽式钢板固定的胫骨高位截骨术(hightibialosteotomy,HTO)治疗膝关节骨性关节炎的手术方法、手术适应证及疗效。方法自1998年5月～2000年1月,采用新型槽式钢板固定的HTO治疗膝关节骨性关节炎70例(108条腿),男14例,女56例;年龄38～76岁,平均59.6岁。新型槽式钢板内固定是采用张力带的原理,手术采用改良的HTO,不切除腓骨小头,不显露腓总神经,闭合楔形截骨,并保持内侧骨膜的完整。结果随访6～20个月,平均12个月。膝关节疼痛基本消失,关节功能不受影响,膝内外翻畸形得到矫正。术后并发症较少,能早期开始功能锻炼。结论新型槽式钢板固定具有操作简便、固定可靠、不影响关节活动等特点,使HTO的优点得到最大发挥。

High fibial osteotomy with fixation of Giebel blade plate for the treatment of osteoarthritis of the knee

Objective To evaluate the results of treatment with the high tibial osteotomy and fixtation with the new Giebel blade plate for osteoarthritis of the knee, and to discuss the indication for this technique. Methods Seventy patients(108 knees), 14 male and 56 female, with an average age of 59.6 years (range 38-76)were reviewed. The average postoperative follow up was 12 months (from 6 to 20 months ). Pain was complained chiefly in the medial aspect of the knee joint and the majority of patients had slight degree of genu varum. This new Giebel blade plate acts as a tension band when it is placed on the site for fixation, the proximal tibial fibular joint was not exposed during surgery so that the fibular head was well preserved, avoiding common peroneal nerve injury. The periosteum opposite to the incision position was left intact for the sake of the stability and acted as a hinge around which the wedge osteotomy was closed. AP and lateral radiography of knee joint was taken pre and post operation for comparison. Results During the follow up, the patients show satisfied pain relief, improvement of joint function, correction of the deformity either genu varum or valgum. Earlier rehabilitation exercise should be carried out and the complication was rare. Conclusion The characteristics of this method are its convenient application, the stable fixation and the well preserved joint function. The advantage of high tibial osteotomy was shown sufficiently by the use of Giebel blade plate.