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中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 366 -374. doi: 10.3877/cma.j.issn.1674-134X.2026.03.014

综述

膝关节周围截骨矫形术研究进展
万贤杰, 丁勇, 刘智博, 郭建斌()   
  1. 710054 西安交通大学附属红会医院关节病医院保膝科
  • 收稿日期:2025-06-03 出版日期:2026-06-01
  • 通信作者: 郭建斌
  • 基金资助:
    陕西省社发公关项目(2024SF-YBXM-383)

Research progress in periarticular osteotomy and orthoplasty of knee

Xianjie Wan, Yong Ding, Zhibo Liu, Jianbin Guo()   

  1. Department of Knee Preservation, Hospital of Joint Diseases, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
  • Received:2025-06-03 Published:2026-06-01
  • Corresponding author: Jianbin Guo
引用本文:

万贤杰, 丁勇, 刘智博, 郭建斌. 膝关节周围截骨矫形术研究进展[J/OL]. 中华关节外科杂志(电子版), 2026, 20(03): 366-374.

Xianjie Wan, Yong Ding, Zhibo Liu, Jianbin Guo. Research progress in periarticular osteotomy and orthoplasty of knee[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 366-374.

基于“保膝”理念,膝关节周围截骨术作为目前临床上常用的安全、有效的保膝手术,通过截骨术对骨骼畸形(关节外畸形)进行纠正,改变下肢受力的机械线。因此,膝关节周围截骨术既保留正常的解剖结构,又可以有效缓解患者疼痛、维持膝关节功能、恢复患者部分劳动能力、延缓KOA进展。膝关节周围截骨术主要矫正膝关节内翻畸形及外翻畸形,旨在重新分配膝关节间的负重。目前膝关节周围截骨术种类繁多,各种术式各具优势和相应适应症。本文旨在通过回顾临床实践中不同类型截骨术式的相关研究,总结归纳出常见术式的特点、适应症、优势及劣势等,进而指导临床治疗。

Based on the concept of knee preservation, periarticular knee osteotomy is a commonly used, safe, and effective knee-preserving procedure in clinical practice. It corrects osseous deformities (extra-articular deformities) through osteotomy and modifies the mechanical axis of lower extremity load transmission.Therefore, periarticular knee osteotomy not only preserves the normal anatomical structures but also effectively relieves pain, maintains knee function, restores partial working ability of patients, and delays the progression of knee osteoarthritis (KOA). Periarticular knee osteotomy mainly corrects varus and valgus deformities of the knee joint, aiming to redistribute the load across the knee compartments. At present, there are various types of periarticular knee osteotomies, each with its own advantages and corresponding indications. This article reviewed relevant studies on different osteotomy techniques in clinical practice, summarizes the characteristics, indications, advantages, and disadvantages of common procedures, so as to provide guidance for clinical treatment.

图1 文献筛选流程图
Figure 1 Flowchart of Literature Screening
表1 常见膝关节周围截骨术适应证、优缺点归纳
Table 1 Summary of indications, advantages and disadvantages of common periarticular knee osteotomies
手术方式 示意图 适应证 优点 缺点 相关文献
内侧开放楔形胫骨高位截骨术 上行截骨 膝关节内翻患者(畸形来源主要为胫骨) ①切口损伤小;②操作标准流程;③术中力线调整简单;④畸形角度矫正较为精确;⑤腓总神经损伤的风险很小;⑥后期关节置换操作较为简单 ①髌骨低位风险;②胫骨后倾角增大;③合页骨折;④神经血管损伤;⑤膝前痛 12-13
下行截骨 ①冠状面斜切口骨折延迟愈合及不愈合风险增高;②胫骨后倾角增大;③合页骨折;④神经血管损伤 12,13,14,15,16
外侧闭合楔形胫骨高位截骨术 膝内翻畸形(畸形来源主要为胫骨) ①骨愈合面较小,愈合时间短,初始稳定性较好;②可实现早期负重,有助于患者术后康复;③髌骨高度不受影响 ①技术要求高;②肢体短缩;③术神经血管损伤;④合页骨折风险增大;⑤可能使后倾角减小 17,18,19,20,21,22,23,24
圆顶形高位胫骨截骨术 膝内翻畸形(畸形来源主要为胫骨) ①骨愈合面较小,愈合时间短,初始稳定性较好;②可早期负重;③髌骨高度不受影响 ①容易导致胫骨平台骨折;②过度矫正或矫正不足;③血栓性静脉炎及针道感染;④术中暴露量大且手术技术复杂 25-26
近端腓骨截骨术 膝内翻畸形且手术耐受性差(畸形来源主要为胫骨) ①创伤小;②术后恢复快 ①神经血管损伤风险较高;②后期患者行关节置换术比例较其他术式更高 27,28,29,30,31,32
内侧闭合楔形股骨远端截骨术 膝外翻畸形,合并髌股关节不稳定的膝外翻(畸形来源主要为股骨) ①骨不愈合风险较股骨外侧开放楔形截骨低;②稳定性较股骨外侧开放楔形截骨强;③较小软组织侵扰 ①神经血管损伤风险较高;②合页骨折风险;③肢体短缩 42,43,44
外侧开放楔形股骨远端截骨术 膝外翻畸形,可补偿半月板缺失(畸形来源主要为股骨) 较股骨远端内侧闭合楔形截骨术更为安全简单 ①稳定性较差;②术后不能立即负重;③髂胫束刺激征 37,38,39,40,41
胫骨内侧闭合楔形截骨术 膝外翻畸形时胫骨出现畸形或关节冠状面倾斜小于10°时 ①术后早期负重;②并发症较少 适应证范围较窄 35-36
3D打印个性化截骨导板辅助膝关节周围截骨 各类需要进行精准化、个性化的膝关节周围截骨矫形术 个性化、精准 因此技术需制作截骨导板,需额外增加导板制作费用 45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68
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