术中下肢机械力线精确定位在胫骨高位截骨中的应用

目的:评价术中精确定位下肢机械力线在胫骨高位截骨术中的作用。方法:自2005年3月至2010年7月,收治膝内侧间室骨关节炎患者57例(63膝),男24例,女33例;年龄34～68岁,平均52岁。均行胫骨高位内侧开放截骨术,并在术中运用精确定位下肢机械力线以获取良好截骨角度,分别于术后第3个月和最终随访时拍摄双下肢全长位片,观测股胫角,并运用纽约特种医院膝关节评分标准(HSS评分)分别从疼痛、行走功能、活动度、肌力、屈曲畸形、稳定性等方面评价疗效。结果:57例均获随访,时间24～60个月,平均36.7个月。所有患者截骨部位获得良好愈合,股胫角得到合理矫正,由术前(182.8±2.9)°改变到术后(167.6±2.5)°及末次随访时的(168.1±2.5)°(P<0.01),膝关节外翻恢复正常,术前膝内侧疼痛等症状消失。HSS评分由术前的69.5±7.1提高至术后的91.1±4.9及末次随访时的92.2±5.6(P<0.01)。根据HSS评分标准,术后膝关节功能优43膝,良18膝,中2膝。结论:在胫骨高位内侧截骨手术中,即刻运用金属线精确定位下肢机械力线,能获得良好且个体化的股胫角矫正;该方法简单易行,精准有效。

Application of orientation to the mechanical alignment of lower limbs in operation of high tibial osteotomy

Objective: To evaluate the effects of orientation to the mechanical alignment of lower limbs in high tibial osteotomy(HTO). Methods: From March 2005 to July 2010,the data of 57 patients(63 knees) with medial compartment osteoarthritis were retrospectively analyzed. There were 24 males and 33 females with an average age of 52 years(ranged,34 to 68). HTO was used in all the patients,and with wire the exact orientation to the mechanical alignment of lower limbs was performed in order to obtain good angle of intercepted bone. X-rays of full-length lower limbs were done at the 3rd month after operation and final follow-up,in which femorotibial angle would be observed. Clinical results were evaluated according to Hospital for Special Surgery knee scores(HSS) including pain,function,activities,myodynamia,deformity and instability. Results: All patients were followed up from 24 to 60 months with an average of 36.7 months. All osteotomy site achieved radiographic healing.The femorotibial angle was corrected from preoperative(182.8±2.9)° to postoperative(167.6±2.5)° and (168.1±2.5)°at final follow-up(compared with preoperative data,P < 0.01). Pain relieved and genu valgum recovered. HSS score improved from preoperative 69.5±7.1 to postoperative 91.1±4.9 and 92.2±5.6 at final follow-up. According to HSS standard,43 knees got excellent results,18 good and 2 fair. Conclusion: The orientation to mechanical alignment of lower limbs using wire during operation of HTO is a good method in correcting femorotibial angle and treating medial compartment osteoarthritis of the knee. Moreover,the method is simple and precise for orthopedist.