探讨采用改良单平面截骨及下肢机械力线矫正方法行开放楔形胫骨高位截骨术(OWHTO)治疗膝关节骨关节炎的疗效。

回顾分析2017年5月至2018年6月西安医学院第二附属医院收治并接受OWHTO的28例(36膝)膝关节骨关节炎患者临床资料。其中，2017年5月至2018年1月术中采用传统单平面截骨及下肢机械力线定位矫正方法的11例(14膝)患者归入传统组；2018年2月至2018年6月术中采用改良单平面截骨及下肢机械力线定位矫正方法的18例(22膝)患者归入改良组。比较两组术中透视次数、术中失血量、手术时间、术中及术后发生骨折率；观测两组手术前后下肢机械力线改变，以髋膝踝角(HKA)表示；采用美国特种外科医院膝关节评分(HSS)、美国西安大略与麦克马斯特大学骨关节炎指数评分(WOMAC)评价临床疗效。数据采用独立样本t检验和单因素方差分析。

两组患者年龄、性别、身体质量指数及膝骨关节炎分级之间差异均无统计学意义(P>0.05)，具有可比性。术后传统组2例切口持续渗出，经对症处理后3周愈合；传统组其余患者及改良组全部患者术后切口均Ⅰ期愈合。改良组术中透视次数及手术时间均低于传统组(t ＝5.427，P<0.01；t＝3.328，P<0.01)。两组术中出血量无明显差异(t ＝1.192，P>0.05)。传统组术中3例胫骨外侧皮质发生骨折；改良组术中均未发生骨折。两组患者均获随访，其中传统组随访时间平均(10.7±1.6)个月；改良组随访时间平均(8.2±1.5)个月。术后6个月随访时，两组术前及术后HSS评分(t_传统＝29.797，t_改良＝20.611)、WOMAC评分(t_传统＝12.748，t_改良＝20.179)比较，差异均有统计学意义(P<0.05)；两组间比较，差异均无统计学意义(P>0.05)。术后X线片复查示，两组患者股胫角均得到纠正。两组术后1 d及6个月随访时HKA角较术前均提高(P<0.05)。

与传统单平面截骨及下肢机械力线定位方法相比，OWHTO术中采用改良单平面截骨及下肢机械力线矫正方法，可降低骨折发生率，降低术中透视次数，缩短手术时间，进而有效减少医患双方辐射暴露、提高手术疗效，临床效果满意。

To evaluate the effects of the improved method of single plane osteotomy and lower limbs mechanical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).

A retrospectiveanalysis was made on the clinical data of 28 patients (36 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between May 2017 to June 2018. The traditional method for single plane osteotomy and positioning lower limb mechanical force line was used in 11cases (14 knees), and modified method for single plane osteotomy and positioning lower limb mechanical force line was used in 18 cases (22 knees) (modified group). The intraoperative fluoroscopy times, intraoperative blood loss and operation time were compared between the two groups. Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University osteoarthritis index (WOMAC). The data were analyzed by t test and one-way ANOVA.

There was no significant difference in age, gender, body mass index and osteoarthritis grading between two groups (P>0.05). Incision hematoma occurred in two case of traditional group and was cured at three weeks after symptomatic treatment. Primary healing was obtained in the other patients, with no early complications. The intraoperative fluoroscopy times, operation time of the modified group were significantly lower than those of the traditional group (t=5.427, P<0.01; t=3.328, P<0.01). There was no significant difference in intraoperative bleeding volume between the two groups (t=1.192, P>0.05). There were three cases of fractures in the traditional group. The patients were followed up in the traditional group for(10.7±1.6)months in average in the modified group, and for (8.2±1.5)months in the modified group. At the follow-up of six months after operation, the HSS score(traditional group t=29.797, modified group t=20.611)and WOMAC score(traditional group t=12.748, modified group t=20.179) were significantly improved when compared with preoperative scores in two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at one day and six months follow-up after operation was significantly higher than those pre-operation in two groups (P<0.05).

Compared with the traditional method of single plane osteotomy and lower limbs mechanical alignment, the modified method of single plane osteotomy and lower limbs mechanical alignment can reduce the incidence of fracture, and reduce the intraoperative fluoroscopy, shorten the operation time, which reduces the radiation exposure of both doctors and patients, thus the effect of high operation is satisfactory.