【摘要】：目的:分析脛骨高位截骨術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的中長期療效。方法:自2001年1月至2005年12月,采用脛骨高位截骨術(shù)治療45例63膝關(guān)節(jié)內(nèi)側(cè)間室骨性關(guān)節(jié)炎患者,其中男性患者10例(15膝),女性患者35例(48膝),年齡45-64歲,平均(54.76±5.54)歲。術(shù)前常規(guī)行膝關(guān)節(jié)負(fù)重正側(cè)位X線檢查,準(zhǔn)確測量股脛角大小,根據(jù)術(shù)前股脛角決定脛骨外側(cè)截骨量,手術(shù)均在硬膜外麻醉下常規(guī)行脛骨高位截骨術(shù),大部分行腓骨中段截骨,部分病例行上脛腓關(guān)節(jié)松解,術(shù)后第2天即行功能鍛煉,2周開始無負(fù)重下床活動,術(shù)后8-10周開始負(fù)重。術(shù)后第2天、8-10周、半年、1年及以后每年1次拍片復(fù)查,對全部病例術(shù)前、術(shù)后3-5年、術(shù)后10-14年進(jìn)行視覺模擬評分(VAS)、美國特種外科醫(yī)院膝關(guān)節(jié)評分(HSS)和美國膝關(guān)節(jié)協(xié)會評分(KSS)評價膝關(guān)節(jié)疼痛、畸形、功能和運動范圍。并對50膝關(guān)節(jié)采用單髁置換術(shù)治療膝骨性關(guān)節(jié)炎患者的HSS、KSS評分比較做統(tǒng)計學(xué)分析。結(jié)果:43例(61膝)進(jìn)行了10年及以上的隨訪,全部病人手術(shù)切口Ⅰ期愈合,術(shù)后8-10周截骨處均達(dá)骨性愈合。術(shù)后10-14年HSS評分平均76.24±5.27,優(yōu)27膝,良25膝,可7膝,差2膝。術(shù)前與術(shù)后3-5年、術(shù)前與術(shù)后10-14年VAS、HSS、KSS比較有差異,術(shù)后3-5年與術(shù)后10-14年各項評分無明顯差異。與UKA對照組的HSS、KSS評分比較無明顯差異。結(jié)論:脛骨高位截骨治療膝關(guān)節(jié)骨性關(guān)節(jié)炎(內(nèi)側(cè)間室關(guān)節(jié)炎)只要手術(shù)指征掌握適當(dāng),術(shù)后積極鍛煉,其中長期療效滿意。
[Abstract]:Objective: to analyze the long-term effect of high tibial osteotomy on knee osteoarthritis. Methods: from January 2001 to December 2005, 45 cases (15 knees) were treated with high tibial osteotomy, including 10 male (15 knees) and 35 female (48 knees), aged 45-64 years (mean 54.76 鹵5.54). X ray examination of knee joint loading and lateral position was performed before operation, the size of femoral tibial angle was measured accurately, and the amount of lateral tibia osteotomy was determined according to the preoperative femoral tibial angle. High tibial osteotomy was performed under epidural anesthesia, and fibula osteotomy was performed in most cases. In some cases, the upper tibiofibular joint was loosened, and the second day after operation, the functional exercise was carried out for 2 weeks, and the weight was carried out from 8 to 10 weeks after operation. The second day after operation was 8-10 weeks, half a year, one year and one year thereafter. All cases were examined before and after operation for 3-5 years. Visual analogue scale (VAS),) and American knee Association score (KSS) were performed 10-14 years after operation to evaluate knee pain, deformity, function and motor range. The HSS KSS scores of 50 patients with knee osteoarthritis treated by single condylar replacement were statistically analyzed. Results 43 cases (61 knees) were followed up for 10 years or more. All the patients were healed at the first stage of the incision. The osteotomy was achieved at 8 to 10 weeks after operation. The average HSS score was 76.24 鹵5.27, excellent in 27 knees, good in 25 knees, fair in 7 knees and poor in 2 knees. There were significant differences between preoperative and postoperative 3-5 years, preoperative and postoperative 10-14 years in VAS-HSS-KSS, but there was no significant difference between 3-5 years after operation and 10-14 years after operation. There was no significant difference between HSS and KSS scores in UKA control group. Conclusion: the treatment of knee osteoarthritis (medial compartment arthritis) with high tibial osteotomy is satisfactory in the medium and long term as long as the operative indications are properly grasped and active exercise is taken after the operation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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