Application of high tibial osteotomy in aged degenerative knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2022.03.015

Abstract

Abstract:

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.

Key words: Tibia, Osteotomy, Aged, Knee osteoarthritis

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

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References 62

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病史	影像学	体格检查	其他因素
实际生理年龄	解剖力线	畸形程度方向	患者的期望值
患者所需的生活水平	机械力线	先前的切口	手术医生的能力
疼痛位置	关节炎的严重程度畸形的程度	身体状况活动范围	动态步态因素软组织张力身体上部的活动
特点髌股关节	髌股关节半脱位	总活动度屈曲挛缩	潜在并发症
风湿性疾病情况	其他间室的情况	韧带缺失	术后恢复制动时间
既往半月板切除史	关节软骨丢失的情况	髌股关节机械力学	术后患者恢复的依从性
感染病史	焦磷酸钙沉积骨质缺损关节处的变形膝关节后倾	内收肌力量	易于进行全膝关节置换

病史	影像学	体格检查	其他因素
实际生理年龄	解剖力线	畸形程度方向	患者的期望值
患者所需的生活水平	机械力线	先前的切口	手术医生的能力
疼痛位置	关节炎的严重程度畸形的程度	身体状况活动范围	动态步态因素软组织张力身体上部的活动
特点髌股关节	髌股关节半脱位	总活动度屈曲挛缩	潜在并发症
风湿性疾病情况	其他间室的情况	韧带缺失	术后恢复制动时间
既往半月板切除史	关节软骨丢失的情况	髌股关节机械力学	术后患者恢复的依从性
感染病史	焦磷酸钙沉积骨质缺损关节处的变形膝关节后倾	内收肌力量	易于进行全膝关节置换

绝对禁忌	相对禁忌
弥漫性、非特异性膝关节痛	年龄大于60岁
原发性髌股关节痛	膝关节活动弧度小于90°
外侧间室的半月板切除	肥胖(>1.3倍的理想体重)
外侧间室的关节炎	胫股关节半脱位
潜在的关节感染性疾病	严重关节炎
不切实际的患者期望值	中、重度韧带不稳定

绝对禁忌	相对禁忌
弥漫性、非特异性膝关节痛	年龄大于60岁
原发性髌股关节痛	膝关节活动弧度小于90°
外侧间室的半月板切除	肥胖(>1.3倍的理想体重)
外侧间室的关节炎	胫股关节半脱位
潜在的关节感染性疾病	严重关节炎
不切实际的患者期望值	中、重度韧带不稳定

Ⅰ级	关节间隙变窄(50%关节软骨磨损)
Ⅱ级	关节线消失
Ⅲ级	轻度骨磨损
Ⅳ级	中度骨磨损(磨损0.5~1cm)
Ⅴ级	严重骨磨损及存在关节半脱位

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