内侧开放性胫骨高位截骨治疗内翻膝关节炎的临床疗效

目的探讨内侧开放性胫骨高位截骨(HTO)治疗内翻膝关节炎的临床疗效。方法34例内翻膝关节炎患者,均采用内侧开放性胫骨高位截骨治疗,并对其进行随访,观察分析患者的手术效果及术后并发症发生情况,同时比较患者术前及术后末次随访时的膝关节功能美国特种外科医院(HSS)评分。结果34例患者均获得随访,随访时间6~12个月,平均随访8.9个月。术后末次随访时,患者中优20例,良13例,可1例,差0例。患者术后末次随访时的膝关节功能HSS评分(89.6±3.9)分高于术前的(63.2±6.4)分,差异具有统计学意义(P<0.05)。术后所有患者的膝关节内侧疼痛症状均得到有效改善,未出现血管神经损伤、内固定断裂及感染等并发症;其中2例外侧铰链皮质骨折患者延迟下地,定期复查后均愈合良好;2例患者因合并皮肤疾病及糖尿病出现伤口愈合不良,经多次换药及伤口护理,于术后1个月左右伤口愈合并给予拆线,术后复查X线提示患者矫形效果满意、下肢力线良好。结论内翻膝关节炎患者采用内侧开放性胫骨高位截骨治疗效果显著,可有效改善患者膝关节疼痛症状,且术后并发症少。

Clinical effect of medial opening high tibial osteotomy in treatment of knee osteoarthritis associated with varus tibial deformity

Objective To discuss the clinical efficacy of medial opening high tibial osteotomy(HTO)in treatment of knee osteoarthritis associated with varus tibial deformity.Methods A total of 34 patients with knee osteoarthritis associated with varus tibial deformity all treated by medial opening high tibial osteotomy,and they were followed up.The surgical effect and postoperative complications were observed and analyzed.Meanwhile,the hospital for special surgery(HSS)score of knee function before operation and at the last follow-up after operation was compared.Results 34 patients were followed up for 6-12 months,with an average of 8.9 months.At the last follow-up,there was 20 excellent cases,13 good cases,1 fair case and 0 poor case.The HSS score of knee function(89.6±3.9)points at the last follow-up after operation was higher than(63.2±6.4)points before operation,and the difference was statistically significant(P<0.05).The pain symptoms of the medial knee joint in all patients were effectively improved,and there were no complications such as vascular nerve injury,internal fixation fracture and infection.2 patients with side hinge cortical fracture were delayed to go to the ground,and healed well after regular reexamination;2 patients suffered from poor wound healing due to skin diseases and diabetes mellitus,and after multiple dressing changes and wound care,the wound healed and the suture was removed about 1 month after the operation.The reexamination of X-ray after the operation indicated that the patients had satisfactory orthopedic effect and good lower limb strength line.Conclusion Medial opening high tibial osteotomy shows remarkable therapeutic effect for patient with knee osteoarthritis associated with varus tibial deformity,and it can effectively improve the pain symptom of knee joint with less postoperative complications.