摘要
目的测量胫骨高位截骨术后胫骨后倾角度,并与术前比较,探讨其改变的临床意义。方法1998～2001年,对38例(58膝)膝关节内侧间室骨性关节炎患者行胫骨高位截骨术,男8例(11膝),女30例(47膝);年龄41～65岁,平均55.2岁。采用Gieble槽式钢板内固定的闭合楔形截骨。截骨线位于胫骨结节上方,距关节面约2 cm。在术前、术后侧位X线片上测量胫骨后倾角度,即胫骨平台关节面与胫骨纵轴的垂直线的夹角;使用Insall-Salvati指数测量髌骨高度,即髌腱长度(从髌骨下极到胫骨结节)和髌骨长度(髌骨的最长径)的比值,并计算胫骨后倾角度和髌骨高度在手术前后的变化。采用配对t检验进行统计学分析,以P<0.01为差异有显著性意义。结果胫骨高位截骨术前胫骨后倾角度平均为9.4°±3.0°,术后平均为5.6°±2.6°,术后较术前平均减小3.8°±2.0°。手术前、后胫骨后倾角度比较差异有显著性意义(P<0.01)。Insall-Salvati比值术前平均为1.05±0.16,均大于0.8;术后平均为0.94±0.18,有7膝小于0.8;术后较术前平均减小0.15±0.10。手术前、后Insall-Salvati比值,即髌骨高度,比较差异有显著性意义(P<0.01)。结论胫骨后倾角度在胫骨高位截骨术后明显减小,可导致髌骨低位等一系列并发症,将对再行全膝关节置换术产生不良影响。
Objective High tibial osteotomy was an alternative in the management of knee osteoarthritis, it could release the knee pain, correct the mechanical axis of the affected limb, and delay the total knee replacement. We were aimed at measuring the change of posterior slope angle of tibial medial plateau after high tibial osteotomy and probe its clinical consequences. Methods From 1998 to 2001, there were fifty-eight knees of 38 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy. The present included 8 male and 30 female patients with the average age of 55.2 years ranging 41 to 65 years. The osteotomy line was 2 cm distal to articular surfaces, and the tibia was fixed with Giebel bladed plate and two oblique long screws. The posterior slope angles of tibia and Insall-Salvati index were measured both pre and postoperatively on lateral radiographs. The posterior slope angle of proximal tibia in this study was defined as the angle between vertical line to tibial axis and the surface parallel to subchondral bone. Insall-Salvati index was defined as the ratio of the length of patellar tendon to the largest vertical diameter of patella. The alteration of the above features was calculated and analyzed statistically with paired t test. Results The mean tibial posterior slope angle was 9.4°±3.0° preoperatively and 5.6°±2.6°postoperatively. The tibial posterior slope angle was averagely decreased about 3.8°±2.0°, Insall-Salvati index was 1.05±0.16 and 0.94±0.18 before and after high tibial osteotomy respectively. This index was averagely decreased about 0.15±0.10. Statistical analysis indicated that there was significant difference of posterior slope angle or Insall-Salvati index between pre and post operative(P< 0.01). There were 7 cases of patella baja detected postoperatively, whereas none was found preoperatively. Conclusion The loss of tibial posterior slope angle after high tibial osteotomy may lead to such complications as patellar baja. Decreased tibial pos
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第8期452-454,共3页
Chinese Journal of Orthopaedics
