内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎

被引：28

作者：

王飞

陈百成

高石军

张建兵

刘虎

闫昌葆

机构：

[1] 河北医科大学第三医院关节骨科

来源：

中华骨科杂志 | 2010年 / 06期

关键词：

骨关节炎,膝; 截骨术; 胫骨;

D O I：

暂无

中图分类号：

R687.3 [骨骼手术];

学科分类号：

100220 [骨科学];

摘要：

目的比较两种胫骨高位截骨术的手术方法和临床结果。方法膝内翻骨关节炎患者68例,其中37例采用外侧闭合胫骨高位截骨术(closed wedge high tibial osteotomy,CWO),31例采用内侧撑开胫骨高位截骨术(open wedge high tibial osteotomy,OWO)。术后摄X线片测量胫骨平台后倾角、髌骨高度、胫骨股骨角、内侧胫股关节间隙宽度,并行HSS和Lysholm功能评分。结果患者均随访24个月以上。术前、术后两组HSS和Lysholm评分差异均无统计学意义。(1)CWO组术前胫骨平台后倾角8.57°±1.63°、术后5.03°±1.24°,OWO组术前8.71°±1.66°、术后10.10°±1.30°,差异均有统计学意义。(2)CWO组术前Insall-Salvati指数0.880±0.053、术后0.820±0.049,差异有统计学意义;OWO组术前0.892±0.043、术后0.897±0.042,差异无统计学意义。CWO组术前Blackburne-Peel指数0.804±0.040、术后0.801±0.339,差异无统计学意义;OWO组术前0.815±0.039、术后0.766±0.037,差异有统计学意义。(3)术后CWO组外翻8.06°±2.75°,OWO组外翻8.65°±1.46°。结论膝内翻骨关节炎的内侧撑开和外侧闭合胫骨高位截骨术有相似的手术效果,内侧撑开截骨术截骨角度更加准确。外侧闭合胫骨高位截骨术后可出现胫骨后倾减小和髌韧带短缩,内侧撑开截骨术后易出现胫骨后倾增加和髌骨至关节线距离减小。

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