切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 93 -98. doi: 10.3877/cma.j.issn.1674-134X.2022.01.015

综述

胫骨高位截骨术治疗膝内侧骨关节炎的研究进展
陈志刚1, 朱鹏1, 李博1, 赵晨1, 周涛1, 周鹏飞1, 吴廷瑞1, 刘琮1, 鲍亮1, 薛欣1, 张兵1,†()   
  1. 1. 710038　西安医学院第二附属医院
  • 收稿日期:2020-07-05 出版日期:2022-02-01
  • 通信作者: 张兵
  • 基金资助:
    2021年陕西省教育厅科研计划项目(21JK0892)

Research progress of high tibial osteotomy in treatment of medial knee osteoarthritis

Zhigang Chen1, Peng Zhu1, Bo Li1, Chen Zhao1, Tao Zhou1, Pengfei Zhou1, Tingrui Wu1, Cong Liu1, Liang Bao1, Xin Xue1, Bing Zhang1,†()   

  1. 1. The Second Affiliated Hospital of Xi 'an Medical College, Xi′an 710038, China
  • Received:2020-07-05 Published:2022-02-01
  • Corresponding author: Bing Zhang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈志刚, 朱鹏, 李博, 赵晨, 周涛, 周鹏飞, 吴廷瑞, 刘琮, 鲍亮, 薛欣, 张兵. 胫骨高位截骨术治疗膝内侧骨关节炎的研究进展[J]. 中华关节外科杂志(电子版), 2022, 16(01): 93-98.

Zhigang Chen, Peng Zhu, Bo Li, Chen Zhao, Tao Zhou, Pengfei Zhou, Tingrui Wu, Cong Liu, Liang Bao, Xin Xue, Bing Zhang. Research progress of high tibial osteotomy in treatment of medial knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(01): 93-98.

骨关节炎(OA)是一种以软骨退行性变为主的疾病。该病常见于老年患者，病程末期可致严重的关节畸形，给患者的心理和生理带来极大的痛苦。胫骨高位截骨术(HTO)作为治疗内侧单间室膝关节骨关节炎(KOA)的一种安全、可靠的手术方式已被广大医生及患者接受，特别是年轻患者的接受度更高。该技术的主要目的是改变下肢畸形力线，以延缓或解除膝内侧间室骨关节炎的退行性改变。HTO一直被认为具有技术简单、手术创伤小、畸形矫正精确、术后恢复快等优点。多年来，随着手术技术的不断创新、内固定的不断改良，手术的适应证变得更为广泛。目前普遍认为HTO是一种比较理想的手术方式，长期临床效果良好。本文对近年来胫骨高位截骨术治疗内侧单间室骨关节炎的术前选择、手术方式、并发症以及生存率等方面进行综述。

关键词: 胫骨, 截骨术, 骨关节炎

Osteoarthritis (OA) is a degenerative disease of cartilage.The disease is common in the elderly patients, the final stage of the disease leads to severe joint deformity, as well as to the patient′s psychological and physical pain.High tibial osteotomy (HTO) is a safe and reliable surgical method for the treatment of medial single-compartment knee osteoarthritis (KOA), which has been widely accepted by doctors and patients, especially young patients. The main objective of this technique is to alter the deformity line of the lower limb in order to delay or relieve the degenerative changes of medial single-compartment KOA. HTO has been considered to have the advantages of simple technique, less surgical trauma, accurate deformity correction and fast postoperative recovery. Over the years, with the continuous innovation of surgical techniques and improvement of internal fixation, surgical indications have become more extensive. Currently, HTO is generally considered to be an ideal surgical method with good long-term clinical results. This article reviewed the preoperative selection, surgical methods, complications and survival rate of high tibial osteotomy for the treatment of medial single-compartment knee osteoarthritis in recent years.

Key words: Tibia, Osteotomy, Osteoarthritis
[1]
Adebajo AO. Pattern of osteoarthritis in a West African teaching hospital[J]. Ann Rheum Dis, 1991, 50(1): 20-22.
[2]
Chang A, Hurwitz D, Dunlop D, et al. The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis[J]. Ann Rheum Dis, 2007, 66(10): 1271-1275.
[3]
Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee[J]. Acta Orthop Belg，1982, 48(1): 93-96.
[4]
黄野．胫骨高位截骨术治疗膝关节骨关节炎的现状[J/CD]．中华关节外科杂志(电子版)，2016，10(5): 470-473.
[5]
Jung WH, Takeuchi R, Chun CW, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy[J]. Arthroscopy, 2014, 30(1): 72-79.
[6]
赵新文，李钊，丁勇，等．胫骨高位截骨治疗膝关节骨性关节炎临床疗效分析[J]．中国骨与关节损伤杂志，2016，31(12): 1272-1276.
[7]
赵振文，王承祥，柳海平，等．体重指数对胫骨高位截骨手术临床疗效的影响[J]．中国骨与关节损伤杂志，2005，20(3): 198-199.
[8]
Meidinger G, Imhoff AB, Paul J, et al. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 333-339.
[9]
Miller BS, Downie B, Mcdonough EB, et al. Complications after medial open-wedge high tibial osteotomy[J]. Arthroscopy, 2009, 25(6): 639-646.
[10]
Billings A, Scott DF, Camargo MP, et al. High tibial osteotomy with a calibrated osteotomy guide，rigid internal fixation，and early mo-tion-Long-term follow-up[J]. J Bone Joint Surg Am, 2000, 82(1): 70-79.
[11]
Müller M, Strecker W. Arthroscopy prior to osteotomy around the knee？[J]. Arch Orthop Trauma Surg, 2008, 128(11): 1217-1221.
[12]
Lee SH, Lee OS, Teo SH, et al. Change in gait after high tibial osteotomy: a systematic review and meta-analysis[J]. Gait Posture, 2017, 57(57): 57-68.
[13]
Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints[J]. Orthop Clin North Am, 1979, 10(3): 585-608.
[14]
Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length[J]. Clin Orthop Relat Res, 1992, (274): 248-264.
[15]
Myrnerts R. Optimal correction in high tibial osteotomy forvarusdeformity[J]. Acta Orthop Scand, 1980, 51(4): 689-694.
[16]
Koshino T, Tsuchiya K. The effect of high tibial osteotomy on osteoarthritis of the knee[J]. Int Orthop, 1979, 3(1): 37-45.
[17]
Kettelkamp DB, Wenger DR, Chao EY, et al. Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force[J]. J Bone Joint Surg Am, 1976, 58(7): 952-960.
[18]
Chillag KJ, Nicholls PJ. High tibial osteotomy: a retrospective analysis of 30 cases[J]. Orthopedics, 1984, 7(12): 1821-1822.
[19]
曹立峰，裴宪武，李延明，等．改良胫骨高位截骨术治疗膝骨性关节炎32例报告[J]．北京医学，2008，30(3): 187-188.
[20]
Hohmann E, Bryant A, Imhoff AB. The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(5): 454-459.
[21]
王兴山，柳剑，顾建明，等．改良闭合楔形胫骨高位截骨术治疗膝内翻畸形的疗效观察[J/CD]．中华关节外科杂志(电子版)，2016，10(5): 474-480.
[22]
Song EK, Seon JK, Park SJ, et al. The complications of high tibial osteotomy: closing- versus opening-wedge methods[J]. J Bone Joint Surg Br, 2010, 92(9): 1245-1252.
[23]
Efe T, Ahmed G, Heyse TJ, et al. Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up[J/OL]. BMC Musculoskelet Disord, 2011, 12：46. DOI：10.1186/1471-2474-12-46.
[24]
Wootton JR, Ashworth MJ, Maclaren CA. Neurological complications of high tibial osteotomy--the fibular osteotomy as a causative factor：a clinical and anatomical study[J]. Ann R Coll Surg Engl, 1995, 77(1): 31-34.
[25]
Nakamura E, Mizuta H, Kudo S, et al. Open-wedge osteotomy of the proximal tibia with hemicallotasis[J]. J Bone Joint Surg Br, 2001, 83(8): 1111-1115.
[26]
张纪，杜辉，黄野，等．胫骨高位截骨术：闭合与开放楔形截骨对比[J]．临床军医杂志，2016，44(2): 128-132.
[27]
张杭，何森．胫骨高位截骨术治疗膝内翻骨关节炎的研究进展[J]．天津医药，2019，47(3): 322-328.
[28]
El-Assal MA, Khalifa YE, Abdel-Hamid MM, et al. Opening-wedge high tibial osteotomy without bone graft[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 961-966.
[29]
Spahn G. Complications in high tibial (medial opening wedge) osteotomy[J]. Arch Orthop Trauma Surg, 2004, 124(10): 649-653.
[30]
徐亚风，罗从风，张长青，等．内侧张开胫骨高位截骨术中未植骨的预后研究[J]．国际骨科学杂志，2015，36(2): 146-150.
[31]
Türkmen F, Sever C, Kaclra BK, et al. Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer[J]. Eur J Orthop Surg Traumatol, 2014, 24(8): 1549-1555.
[32]
肖兴雷，张志刚，陈德生，等．胫骨高位截骨术治疗膝关节单间室骨性关节炎伴内翻畸形的研究进展[J]．中国医药指南，2013，11(35): 343-345.
[33]
王兴山，黄野．开放楔形胫骨高位截骨术的研究进展[J/CD]．中华关节外科杂志(电子版)，2016，10(5): 525-529.
[34]
Nelissen EM, Van LE, Nelissen RG. Stability of medial opening wedge high tibial osteotomy: a failure analysis[J]. Int Orthop, 2010, 34(2): 217-223.
[35]
Kim KJ, Song EK, Seon JK, et al. Biomechanical study of the fixation plates for opening wedge high tibial osteotomy[J]. Knee Surg Relat Res, 2015, 27(3): 181-186.
[36]
Bin SI, Kim HJ, Ahn HS, et al. Changes in patellar height after opening wedge and closing wedge high tibial osteotomy: a meta-analysis[J]. Arthroscopy, 2016, 32(11): 2393-2400.
[37]
El-Azab H, Glabgly P, Paul J, et al. Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy：a radiological study on 100 patients[J]. Am J Sports Med, 2010, 38(2): 323-329.
[38]
赵允，胡文晋，黄竞敏，等．内侧撑开高位胫骨截骨术联合调整胫骨平台后倾角治疗屈曲受限型膝内翻骨关节炎的早期疗效[J]．中国修复重建外科杂志，2018，32(2): 157-161.
[39]
Wang JH, Bae JH, Lim HC, et al. Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope[J]. Am J Sports Med, 2009, 37(12): 2411-2418.
[40]
徐海军，黄野．闭合楔形胫骨高位截骨的并发症[J/CD]．中华关节外科杂志(电子版)，2016，10(5): 535-540.
[41]
Dexel J, Fritzsche H, Beyer F, et al. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 832-837.
[42]
Lee OS, Lee YS. Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy[J]. Arthroscopy, 2018, 34(4): 1032-1043.
[43]
Nakamura R, Komatsu N, Murao T, et al. The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy[J]. Bone Joint J, 2015, 97-B(9): 1226-1231.
[44]
Kessler OC, Jacob HA, Romero J. Avoidance of medial cortical fracture in high tibial osteotomy: improved technique[J]. Clin Orthop Relat Res, 2002, 395(395): 180-185.
[45]
Hinterwimmer S, Beitzel K, Paul J, et al. Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy[J]. Am J Sports Med, 2011, 39(4): 851-856.
[46]
Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy[J]. Orthopedics, 2007, 30(10 Suppl): S127-S131.
[47]
Nakamura R, Komatsu N, Fujita K, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy[J]. Bone Joint J, 2017, 99-B(10): 1313-1318.
[48]
Berman AT, Bosacco SJ, Kirshner S, et al. Factors influencing long-term results in high tibial osteotomy[J]. Clin Orthop Relat Res, 1991, (272): 192-198.
[49]
Flecher X, Parratte S, Aubaniac JM, et al. A 12-28-year follow-up study of closing wedge high tibial osteotomy[J]. Clin Orthop Relat Res, 2006, 452: 91-96.
[50]
Hernigou P, Medevielle D, Debeyre J, et al. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study[J]. J Bone Joint Surg Am, 1987, 69(3): 332-354.
[51]
Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up[J]. J Bone Joint Surg Br, 1990, 72(2): 238-244.
[52]
Koh IJ, Kim MS, Sohn S, et al. Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis[J]. Orthop Traumatol Surg Res, 2019, 105(1): 77-83.
[53]
Giagounidis EM, Sell S. High tibial osteotomy: factors influencing the duration of satisfactory function[J]. Arch Orthop Trauma Surg, 1999, 119(7/8): 445-449.
[54]
Naudie D, Bourne RB, Rorabeck CH, et al. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study[J]. Clin Orthop Relat Res, 1999, (367): 18-27.
[55]
Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits[J]. Joints, 2016, 4(2): 98-110.
[56]
Odenbring S, Egund N, Knutson K, et al. Revision after osteotomy for gonarthrosis. A 10-19-year follow-up of 314 cases[J]. Acta Orthopaedica Scandinavica, 61(2): 128-130.
[57]
Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(2): 149-152.
[58]
Duivenvoorden T, Van Diggele P, Reijman M, et al. Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 895-901.
[59]
Kim JH, Kim HJ, Lee DH. Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis[J/OL]. Sci Rep, 2017, 7(1): 7296. DOI: 10.1038/s41598-017-07856-8.
[60]
Ducat A, Sariali E, Lebel B, et al. Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study[J]. Orthop Traumatol Surg Res, 2012, 98(1): 68-74.
[61]
Takeuchi R, Ishikawa H, Kumagai K, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture[J]. Arthroscopy, 2012, 28(1): 85-94.
[1] 刘瀚忠, 黄生辉, 万俊明, 李家春, 舒涛. 髌上入路和髌旁外侧入路髓内钉治疗胫骨骨折疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 795-801.
[2] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[3] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[4] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[5] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[6] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[7] 刘伦, 王云鹭, 李锡勇, 韩鹏飞, 张鹏, 李晓东. 机器人辅助膝关节单髁置换术的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 715-721.
[8] 杨国栋, 张辉, 郭珈, 曲迪, 张静, 戚超. 外侧半月板后角撕裂是否修复的术后疗效对比[J]. 中华关节外科杂志(电子版), 2023, 17(05): 619-624.
[9] 夏效泳, 王立超, 朱治国, 丛云海, 史宗新. 深度塌陷性胫骨平台骨折的形态特点和治疗策略[J]. 中华关节外科杂志(电子版), 2023, 17(05): 625-632.
[10] 张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.
[11] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[12] 王岩, 马剑雄, 郎爽, 董本超, 田爱现, 李岩, 孙磊, 靳洪震, 卢斌, 王颖, 柏豪豪, 马信龙. 外泌体在骨质疏松症诊疗中应用的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 673-678.
[13] 赵之栋, 李众利. 骨关节炎早期诊治的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 689-693.
[14] 王旭, 师绍敏, 毛燕, 季上, 刘亚玲. 肝酶代谢与骨关节炎相关性的研究进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 379-384.
[15] 周晓强, 孙超, 虞宵, 金宇杰, 李志强, 张向鑫, 陈广祥. 同一患者同期行全膝和单髁置换术的早期临床疗效[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 275-281.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号