胫骨近端_____膝关节；_内翻；_胫骨近端；

胫骨高位截骨术治疗膝内翻伴膝外摆步态的疗效与不足

http://www.100md.com 《中国矫形外科杂志》 2006年第5期

胫骨近端,,膝关节；,内翻；,胫骨近端；,截骨；,关节不稳；,膝外摆,1资料与方法,2结果,3讨论,参考文献：

     摘要：[目的]探讨外侧闭合胫骨高位截骨术治疗膝内翻伴膝外摆步态患者的临床效果及相关的影响因素。[方法]随访2000～2004年因膝内翻伴膝外摆步态于本院行胫骨高位截骨手术的患者19例，年龄47～54岁，随访时间6个月～4 a。术前及术后X线片测量股骨-胫骨角、胫骨平台后倾角和腓骨小头高度，HSS膝关节功能评分，关节后外侧稳定性测试，术后患者以五点问卷法评价术后关节稳定性的改善情况。[结果]股骨-胫骨角术前1845°～197°，术后167°～176°；腓骨小头高度术前773～185 mm，术后-35～107 mm；胫骨后倾角术前2°～17°，术后-4°～13°；HSS评分术前48～68分，术后60～91分(P=000)。后外侧的稳定性测量术前Ⅰ度损伤16例，Ⅱ度损伤3例。术后Ⅰ度损伤9例，Ⅱ度损伤10例(P<005)。术后患者关节稳定性的问卷4例明显提高，9例有提高，6例与术前相同。[结论]外侧闭合胫骨高位截骨治疗膝内翻合并膝外摆的近期效果良好，远期效果可能受到膝外摆步态、胫骨后倾角和腓骨小头高度改变的影响。

    关键词：膝关节；内翻；胫骨近端；截骨；关节不稳；膝外摆

    Lateral thrust of varus knees treated with lateral closing wedge high tibial osteotomy∥WANG Fei,CHEN Jingqing,CHEN Baicheng,et alDepartment of Joint Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051

    Abstract：[Objective]To assess the functional outcome,influence factors and its management of lateral wedge high tibial osteotomy(HTO)in patients with symptomatic lateral thrust and varus malalignment[Method]The results of 19 lateral closing wedge HTOs in patients with a symptomatic hyperextensionvarus thrust were evaluated from 2000 to 2004The average age of the patients at the time of surgery was 49 years(ranged,47~54 years)Radiographs were analyzed to compare changes in femorotibial angle,tibial slope,and the height of the fibular head pre and postoperativelyFunctional results were evaluated according to the scoring system of HSSThe varus stress test was used to evaluated the posterolateral knee injuryWe used a 5point visual analogue scale to assess change in knee stability[Result]Patients were followed for an average of 21 monthsFemorotibial axis alignment was 1845°～197°preoperatively and 167°～176°postoperatively;Posterior tibial slope was 2°～17°preoperatively and -4°～13°postoperatively;The height of fibular head was 77～185 mm preoperatively and -35～107 mm postoperatively(P=000)All patients had an increase in their HSS score postoperativelySixteen patients had Grade 1 posterolateral injuries and 3 patients had Grade 2 injures preoperatively,9 patients had Grades 1 injures and 10 patients had Grade 2 injures(P<005)Four patients rated their knee stability as being significantly better,nine as being better and six as being same[Conclusion]Lateral closing wedge HTO can produce good functional and adiographic result in patients with symptomatic lateral thrust and varus malalignment in the short term,but these results probably deteriorate with timeLateral thrust,change of posterior tibial slope and the height of fibular head would influence long term survival of high tibial osteotomy ......

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