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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 653 -657. doi: 10.3877/cma.j.issn.1674-134X.2024.05.014

综述

内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗
谢佳乐1, 李琦2, 芦升升2, 姜劲松2,()   
  1. 1.046000 长治医学院
    2.044000 山西医科大学附属运城市中心医院
  • 收稿日期:2021-04-26 出版日期:2024-10-01
  • 通信作者: 姜劲松
  • 基金资助:
    山西医科大学附属运城市中心医院院级课题(YJ2023016)

Surgical treatment of medial knee osteoarthritis with coronal subluxation of tibiofemoral joint

Jiale Xie1, Qi Li2, Shengsheng Lu2, Jinsong Jiang2,()   

  1. 1.Changzhi Medical College, Changzhi 046000, China
    2.Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng 044000, China
  • Received:2021-04-26 Published:2024-10-01
  • Corresponding author: Jinsong Jiang
引用本文:

谢佳乐, 李琦, 芦升升, 姜劲松. 内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗[J]. 中华关节外科杂志(电子版), 2024, 18(05): 653-657.

Jiale Xie, Qi Li, Shengsheng Lu, Jinsong Jiang. Surgical treatment of medial knee osteoarthritis with coronal subluxation of tibiofemoral joint[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 653-657.

内侧单间室膝骨关节炎是膝骨关节炎(OA)的主要类型。已有一些研究发现胫股关节冠状半脱位(CTFS)与骨关节炎密切相关,但OA的X线影像学评估中,很少考虑到CTFS的影响作用。开放楔形胫骨高位截骨术(OWHTO)可矫正膝关节的畸形,调整下肢力线,改变关节负荷,从而改善膝关节炎的症状。研究表明对内侧单间室膝骨关节炎患者进行OWHTO,能改善患者膝关节的生物力学状况,促进恢复膝关节功能。本文就近年来关于内侧单间室膝骨关节炎与CTFS的关系、CTFS的测量及OWHTO对CTFS矫正的研究进行总结,更好地为临床工作提供参考。

Medial compartment knee osteoarthritis is the main type of knee osteoarthritis. Some existing studies have found a close relationship between coronaltibiofemoral subluxation and knee osteoarthritis,but the impact of the coronal tibial-femoral subluxation (CTFS) is rarely considered in the X-ray evaluation of knee osteoarthritis (OA). Open wedge high tibial osteotomy (OWHTO) is a commonly used knee-preserving treatment method that can correct knee joint deformities, adjust lower limb alignment, change joint load distribution, and improve symptoms of knee osteoarthritis. Studies have shown that performing OWHTO on patients with medial compartment knee osteoarthritis can improve the biomechanical status of the knee joint and promote the recovery of knee joint function. This article summarized the relationship between medial compartment knee osteoarthritis and CTFS, the measurement of CTFS, and the correction of CTFS by OWHTO in recent years, providing better reference for clinical work.

图1 负重位下肢全长 X 线片上三种方法测量HTO(胫骨高位截骨)术前CTFS(胫股关节冠状半脱位)值。图A示第一种方法:通过股骨外侧髁最外侧点和胫骨平台最外侧点做地面垂线,两条直线之间的距离为CTFS值;图B示第二种方法:股骨干中点(距离股骨远端关节面约120 mm)和髁间窝顶点连线为第一条线,胫骨干中点(距离胫骨近端关节面约120 mm)与胫骨嵴中点的连线为第二条线,两条线与胫骨平台切线交点之间的距离为CTFS值;图C示第三种方法:过股骨髁间窝顶点做胫骨机械轴平行线,两条线之间的距离为CTFS值
Figure 1 Three measurement methods of the preoperative CTFS value for HTO on weight bearing full-length X ray images. A shows first method: a line perpendicular to the ground is made through the outermost point of the lateral femoral condyle and the outermost point of the tibial plateau, the distance between the two straight lines is CTFS value; B shows the second method: the first line is connection between the midpoint of the femoral shaft (about 120 mm away from the distal femoral articular surface) and the apex of the intercondylar fossa,the second line is connection between the midpoint of the tibial shaft (about 120 mm away from the proximal tibial articular surface) and the midpoint of the tibial crest, thus the distance between the intersection points of the two lines and the tangent line of the tibial plateau is the CTFS value; C shows the third method: a parallel line to the tibial mechanical axis is made through the apex of the intercondylar fossa of the femur, and the distance between the two lines is the CTFS value
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