發(fā)布時(shí)間：2018-01-24 16:10

  本文關(guān)鍵詞： 膝關(guān)節(jié) 骨關(guān)節(jié)炎 開放楔形脛骨高位截骨術(shù) 下肢機(jī)械力線　出處：《中國(guó)修復(fù)重建外科雜志》2017年06期 　論文類型：期刊論文

【摘要】：目的探討采用下肢機(jī)械力線改良精準(zhǔn)對(duì)線方法行開放楔形脛骨高位截骨術(shù)(open wedge high tibial osteotomy,OWHTO)治療膝關(guān)節(jié)骨關(guān)節(jié)炎的療效。方法回顧分析2012年1月—2015年12月收治并符合選擇標(biāo)準(zhǔn)的62例(68膝)接受OWHTO的膝關(guān)節(jié)內(nèi)側(cè)單間室骨關(guān)節(jié)炎患者臨床資料。其中,2012年1月—2014年3月共29例(32膝)患者術(shù)中采用傳統(tǒng)方法定位下肢機(jī)械力線(傳統(tǒng)組),2014年4月—2015年12月共33例(36膝)患者術(shù)中采用改良方法定位下肢機(jī)械力線(改良組)。兩組患者性別、年齡、側(cè)別、病程、骨關(guān)節(jié)炎分級(jí)等一般資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。記錄兩組手術(shù)時(shí)間、術(shù)中透視次數(shù)、術(shù)中失血量;手術(shù)前后攝雙下肢全長(zhǎng)X線片,觀測(cè)術(shù)側(cè)下肢機(jī)械力線,以髖膝踝角(hip-knee-ankle angle,HKA)表示;采用美國(guó)特種外科醫(yī)院(HSS)評(píng)分、美國(guó)西部Ontario與Mc Master大學(xué)骨關(guān)節(jié)炎指數(shù)評(píng)分(WOMAC)評(píng)價(jià)臨床療效。結(jié)果術(shù)后傳統(tǒng)組1例截骨部位切口發(fā)生血腫,經(jīng)對(duì)癥處理后3周愈合;其余患者術(shù)后切口均Ⅰ期愈合,無早期并發(fā)癥發(fā)生。改良組手術(shù)時(shí)間、術(shù)中透視次數(shù),均低于傳統(tǒng)組(t=11.934,P=0.000;t=11.663,P=0.000);但兩組術(shù)中失血量比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.209,P=0.835)。兩組患者均獲隨訪,其中傳統(tǒng)組隨訪時(shí)間6~24個(gè)月,平均12.7個(gè)月;改良組隨訪時(shí)間3~22個(gè)月,平均13.2個(gè)月�；颊呦リP(guān)節(jié)內(nèi)側(cè)間隙疼痛癥狀均消失。末次隨訪時(shí),兩組HSS評(píng)分以及WOMAC評(píng)分與術(shù)前比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組間比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后X線片復(fù)查示,兩組患者股脛角均得到糾正。兩組術(shù)后即刻及末次隨訪時(shí)HKA角較術(shù)前提高(P0.05);術(shù)后兩時(shí)間點(diǎn)間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論與傳統(tǒng)下肢機(jī)械力線定位方法相比,OWHTO術(shù)中采用下肢機(jī)械力線改良精準(zhǔn)對(duì)線方法,可減少術(shù)中透視次數(shù)、縮短手術(shù)時(shí)間,減少了醫(yī)患雙方輻射暴露。
[Abstract]:Objective to investigate the open wedge high tibial osteotomy with open wedge-shaped high tibial osteotomy with improved and accurate alignment of mechanical force line of lower extremity. The curative effect of OWHTO) on knee osteoarthritis methods 62 cases (68 knees) treated with OWHTO from January 2012 to December 2015 were retrospectively analyzed. Clinical data of patients with medial single compartment osteoarthritis of knee joint received OWHTO. From January 2012 to March 2014, a total of 29 patients with 32 knees were treated with traditional method to locate the mechanical line of lower extremity (traditional group). From April 2014 to December 2015, 33 patients with 36 knees were treated with improved method to locate the mechanical line of lower extremity (modified group). Sex, age, side and course of disease were used in both groups. Compared with the general data of osteoarthritis, the difference was not statistically significant (P 0.05). The operation time, the times of fluoroscopy and the amount of blood loss in the two groups were recorded. The full-length X-ray films of both lower limbs were taken before and after operation, and the mechanical force lines of the lower extremities were observed, as indicated by hip and knee ankle angle hip-knee-ankle angle HKA. HSS score was used in the United States Special surgery Hospital. Ontario and MC Master University Osteoarthritis Index (Osteoarthritis Index) were used to evaluate the clinical efficacy. Results hematoma occurred in the incision of osteotomy in one case in the traditional group after operation. 3 weeks after symptomatic treatment; In the other patients, all the incisions healed in the first stage, and no early complications occurred. The operation time and the times of fluoroscopy in the modified group were lower than that in the traditional group (11.934 and 0.000). T ~ (11. 663) P ~ (1) 0.000 ~ (-1); However, there was no significant difference in blood loss between the two groups during operation. The patients in both groups were followed up for 6 ~ 24 months. An average of 12.7 months; The patients in the modified group were followed up for 3 ~ 22 months with an average of 13.2 months. The symptoms of pain in the medial space of the knee disappeared. At the last follow-up, the HSS score and the WOMAC score of the two groups were compared with those before operation. The difference was statistically significant (P 0.05). There was no significant difference between the two groups (P 0.05). The femoral tibial angle was corrected in both groups. The HKA angle was increased immediately after operation and at the last follow-up in both groups than that before operation (P 0.05). There was no significant difference between the two time points after operation (P 0.05). Conclusion compared with the traditional positioning method of mechanical force line of lower extremity, OWHTO adopts improved alignment method of mechanical force line of lower extremity. It can reduce the times of intraoperative fluoroscopy, shorten the operation time and reduce the radiation exposure of both doctors and patients.
【作者單位】： 西安交通大學(xué)附屬紅會(huì)醫(yī)院關(guān)節(jié)外科膝關(guān)節(jié)病區(qū);西安交通大學(xué)附屬紅會(huì)醫(yī)院手術(shù)麻醉一科;
【分類號(hào)】：R687.3
【正文快照】： 膝關(guān)節(jié)骨關(guān)節(jié)炎治療經(jīng)過多年研究,在理念和BMI)30;(7)X線片檢查確診骨關(guān)節(jié)炎,Ahlback技術(shù)上均取得了巨大進(jìn)步。對(duì)于活動(dòng)量大、單間分級(jí)≤Ⅱ級(jí)[1-3]。排除標(biāo)準(zhǔn):(1)術(shù)前膝關(guān)節(jié)活動(dòng)室、癥狀較重且保守治療無效的中青年患者,開放120°,屈曲畸形10°;(2)脛骨內(nèi)外側(cè)關(guān)節(jié)面形成楔

【相似文獻(xiàn)】

相關(guān)期刊論文 前3條

1 王大偉,Lo Nagi Nung,Yeo Seng Jing;全膝關(guān)節(jié)置換的放射學(xué)力線測(cè)量[J];中華骨科雜志;2005年09期

2 李子榮;骨性關(guān)節(jié)炎系列講座——必須重視異常肢體力線的矯治[J];中老年保健;1998年02期

3 ;[J];;年期

相關(guān)會(huì)議論文 前3條

1 胡月正;溫宏;潘孝云;余華晨;;術(shù)中下肢機(jī)械力線精確定位在脛骨高位截骨中的應(yīng)用[A];浙江省醫(yī)學(xué)會(huì)骨科學(xué)分會(huì)30年慶典暨2011年浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2011年

2 王波;胡月正;許心弦;溫宏;;髓內(nèi)定位與髓外定位法全膝關(guān)節(jié)置換術(shù)后脛骨假體力線的回顧性分析[A];2012年浙江省骨科學(xué)術(shù)年會(huì)論文集[C];2012年

3 胡月正;王波;溫宏;;不同脛骨定位方法對(duì)全膝置換術(shù)后脛骨假體力線影響的實(shí)驗(yàn)研究[A];2013中國(guó)工程院科技論壇暨浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文摘要集[C];2013年

，

本文編號(hào)：1460445