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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 352 -361. doi: 10.3877/cma.j.issn.1674-134X.2022.03.015

综述

胫骨高位截骨术在老年退变性膝骨关节炎的应用
张海东1, 滕涛,1   
  1. 1. 100062 北京市普仁医院骨科
  • 收稿日期:2020-02-05 出版日期:2022-06-01
  • 通信作者: 滕涛

Application of high tibial osteotomy in aged degenerative knee osteoarthritis

Haidong Zhang1, Tao Teng,1   

  1. 1. Department of Orthopedics, Beijingshi PuRen Hospital, Beijing 100062, China
  • Received:2020-02-05 Published:2022-06-01
  • Corresponding author: Tao Teng
引用本文:

张海东, 滕涛. 胫骨高位截骨术在老年退变性膝骨关节炎的应用[J/OL]. 中华关节外科杂志(电子版), 2022, 16(03): 352-361.

Haidong Zhang, Tao Teng. Application of high tibial osteotomy in aged degenerative knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 352-361.

随着老龄化进展,老年退变性膝骨关节炎越来越多,近年来,随着"保膝"理念的发展,胫骨高位截骨治疗老年退变性膝骨关节炎得到国内、外专家的认可,并得到了快速发展。胫骨高位截骨术是通过转变负重点,纠正下肢力线,使膝关节负重载荷从退变的内侧间室转向相对正常的外侧间室,从而延缓膝关节炎的进展,并促进内侧间室软骨修复,改善膝关节疼痛等症状,逐渐恢复关节活动及功能。早期的胫骨高位截骨术用于相对年轻的患者,但随着老龄化的进展及研究的深入,胫骨高位截骨用于老年退变性膝骨关节炎治疗的研究越来越多,本文对目前胫骨高位截骨术治疗老年退变性膝骨关节炎进行综述。

With the development of aging, degenerative knee osteoarthritis in the elderly is becoming more and more common. In recent years, with the development of the concept of " knee preservation surgery" , high tibial osteotomy for treating degenerative knee osteoarthritis in the elderly has been well-accepted by domestic and foreign experts and has achieved rapid development. High Tibial osteotomy is to transfer the weight-bearing point and weight-bearing loads to the relatively unaffected lateral compartment in varus knees, realign the lower limb line, so as to delay the need for knee replacement by slowing or stopping destruction of the medial joint compartment, and promote the repair of medial compartment cartilage, improve knee joint pain and other symptoms, then gradually restore joint activity and function. Early high tibial osteotomy was used in relatively young elderly patients, but with the development of aging and the research, more and more studies on treatment of elderly degenerative knee osteoarthritis with high tibial osteotomy. This article reviewed how to use high tibial osteotomy to treat of elderly degenerative knee osteoarthritis.

表1 HTO患者的选择因素
表2 HTO患者选择的禁忌因素
图1 膝关节前后位示TBVA (胫骨内翻角)注:TBVA (红色角度标线)是胫骨机械轴(黑色线)与胫骨近端骺线轴(胫骨髁间棘的中点和残存骺线中点的连线)(红色线)的交角
表3 KOA的Ahlback分级
表4 外侧闭合楔形HTO的优缺点和并发症
表5 内侧开放楔形HTO的优缺点和并发症
图2 用下肢全长X线计算胫骨高位截骨术矫正角度的方法注:从股骨头中心和距骨中心的连线在胫骨平台62%的坐标中相交,形成期望的校正角,这个角度需要考虑2~3 mm的关节间隙
表6 HTO术前影像学评估内容
表7 HTO经常选择的截骨点以及矫正角度
图3 胫骨宽度与撑开高度的关系示意图注:给出相同的矫正角度(e),随着胫骨宽度的增加,所需撑开的高度也会增加,当胫骨宽度超过56 mm时,1 mm等于1°的做法会导致矫正不足,故应根据三角函数去实际计算需要撑开的角度
图4 根据三角函数计算撑开的高度b注:a为胫骨宽度,e为计算所得的需要撑开的角度
图5 小腿前后位X线图,示一条带有纵向刻度的腿注:EHLM-踇长伸肌;该图显示了与腓深神经的运动支存在的相关术中损伤高风险区和低风险区
表8 HTO相关的并发症
表9 近10余年HTO主要研究的术后10年生存率
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