摘要
目的 对比分析股骨远端外侧开放楔形截骨术与内侧闭合楔形截骨术治疗膝关节外翻畸形临床疗效及优缺点。方法 笔者自2009-05—2014-06采用股骨远端内翻截骨术＋Tomofix股骨远端锁定钢板内固定治疗50例（61膝）膝外翻畸形,分为观察组（采用股骨远端外侧开放楔形截骨术）和对照组（采用内侧闭合楔形截骨术治疗）。比较2组膝关节损伤与骨关节炎评分（KOOS）、主观满意度指数、股胫角度、膝关节活动度、骨折愈合时间、手术并发症等指标,综合评价该手术方法 对膝关节外翻畸形的治疗效果。结果 1例失访,其余49例获得平均35.1（24~72）个月随访。所有截骨部位全部获得骨性愈合。组内KOOS评分显示术后膝关节结构和功能均获得显著改善,差异有统计学意义（P〈0.01）,但2组间比较差异无统计学意义（P〉0.05）。观察组矫正度数（16.15±3.28）°,对照组矫正度数（15.06±3.65）°,2组间比较差异无统计学意义（P〉0.05）。膝关节活动度、主观满意指数组间和组内比较均无统计学意义（P〉0.05）。观察组骨折愈合时间比对照组慢,差异有统计学意义（P〈0.01）。结论 股骨远端外侧开放楔形截骨术与内侧闭合楔形截骨术矫正膝关节外翻畸形均可取得较理想的治疗效果,内侧闭合楔形截骨骨折愈合较快,但外侧开放楔形截骨术骨量丢失少、手术操作简单,值得推广应用。
Objective To compare and evaluate the effect of distal femoral lateral open-wedge osteotomy and medial close- wedge osteotomy for the treatment for valgus knee. Methods From May 2009 to June 2013, fifty patients （sixty-one knees） were treated with distal femoral osteotomy with Tomofix distal femoral locking plate fixation, which were divided into the observation group （open-wedge osteotomy of the distal femur） and control group （medial close-wedge osteotomy）. The knee injury and osteoarthritis outcome score （KOOS）, and satisfaction index （SI）, tibialfemoral angle, the movement range of knee, bone healing time were investigated before and after operation, respectively, and the effect of the treatment for valgus knee was evaluated. Results One patient was lost for follow-up, others were followed up for an average of 35.1 months （24-72 months）. Bone healing was observed in all patients. Compared with preoperative cases, the surgical operation was able to gain improved knee injury and osteoarthritis outcome seore（P 〈0.01）, but there was no statistical difference between the observation group and control group （P 〉0.05）. The measured tibiofemoral angle was corrected by an average of （16.15±3.28）° in the observation group（P 〈0.01） and （16.15±3.28）° in control group（P 〈0.01）, but there was no statistical difference between the two groups（P 〉0.05）. There were no statistical differences between groups in satisfaction index（SI） and the movement range of knee （P 〉0.05）. Osteotomy healing time in the observation group was slower than that in control group. Conclusion Both lateral open-wedge distal femoral osteotomy and medial close-wedge osteotomy are effective in treatment of valgus knee, and worthy of spreading. However, the medial dose-wedge osteotomy has quicker osteotomy healing time while lateral open-wedge osteotomy has less bone loss and simpler operation.
出处
《中国骨与关节损伤杂志》
2016年第2期149-152,共4页
Chinese Journal of Bone and Joint Injury
关键词
膝外翻
开放截骨术
闭合截骨术
股骨远端
Valgus knee
Open-wedge osteotomy
Medial closing wedge
Distal femoral
