目的 对比使用TomoFix钢板和普通钢板行内侧开放楔形胫骨高位截骨术(medial opening-wedge high tibial osteotomy，MOWHTO)的临床疗效。方法 回顾性分析2017年6月至2020年12月西南医科大学附属医院采用MOWHTO治疗的膝内侧骨关节炎(medial knee osteoarthritis，MKOA)150例患者资料。经过医患沟通后，患者自主选择钢板类型，最终分为两组:78例选择TomoFix钢板(观察组)，其中男33例，女45例，平均年龄(56。7±5。2)岁;72例选择普通钢板(对照组)，其中男30例，女42例，平均年龄(56。6±5。3)岁;所有患者年龄均不超过65岁。比较两组围手术期情况、疼痛视觉模拟评分(visual analogue scale，VAS)、Lysholm评分、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities，WOMAC)评分、国际膝关节文献委员会(international knee documentation committee，IKDC)评分、美国特种外科医院(the hospital special surgery，HSS)评分、膝关节屈伸活动度(range of motion，ROM)及影像资料。结果 两组患者均顺利完成手术，术中无严重并发症。患者均随访12～24个月，对照组平均随访时间(19。2±4。3)个月，观察组平均随访时间(18。6±3。3)个月，组间差异无统计学意义(P＞0。05)。两组术中失血量、术中透视次数、术后负压引流总量、术后负重开始时间、住院天数比较，差异无统计学意义(P＞0。05);手术时间及骨折愈合时间比较，差异有统计学意义(P＜0。05)。与术前相比，末次随访时两组患者的股胫角(femorotibial angle，FTA)、胫骨近端内侧角(medial proximal tibial angle，MPTA)均显著改善(P＜0。05)，但侧位 X 线片上胫骨平台后倾角(posterior tibial slope，PTS)、内侧室Kellgren-Lawrence(K-L)分级无显著改变(P＞0。05)。末次随访时，两组FTA角比较差异有统计学意义(P＜0。05)，两组MPTA角、PTS角、内侧室K-L分级比较差异无统计学意义(P＞0。05)。末次随访时，两组VAS、Lysholm评分、WOMAC评分、IKDC评分、HSS评分、ROM均较术前显著改善(P＜0。05);两组间VAS、Lysholm评分、IKDC评分、ROM差异有统计学意义(P＜0。05)，两组间WOMAC评分、HSS评分差异无统计学意义(P＞0。05)。观察组术后并发症发生率为6。4％，对照组为20。8％，差异有统计学意义(P＜0。05)。结论 MOWHTO术中使用TomoFix钢板内固定，骨折愈合时间短，并发症较少，可获得满意的疗效，减少患者的远期痛苦，显著改善患者膝关节功能。
Comparison of the Efficacy of TomoFix Plate and Common Plate in Medial Open Wedge High Tibial Osteotomy
Objective To compare the clinical efficacy of the TomoFix plate versus a common plate in medial opening-wedge high tibial osteotomy(MOWHTO).Methods A retrospective analysis was performed on data from 150 patients with medial knee osteoarthritis(MKOA)who underwent MOWHTO at the Affiliated Hospital of Southwest Medical University between June 2017 and December 2020.Following doctor-patient consultation,patients autonomously chose the plate type and were subsequently divided into two groups:78 patients selected the TomoFix plate(observation group),comprising 33 males and 45 females,with a mean age of(56.7±5.2)years;72 patients chose the common plate(control group),consisting of 30 males and 42 females,with a mean age of(56.6±5.3)years.All patients were aged under 65 years.The perioperative period,visual analogue scale(VAS),Lysholm score,the Western Ontario and McMaster Universities(WOMAC)score,international knee documentation committee(IKDC)score,the hospital for special surgery(HSS)score,range of motion(ROM),and imaging data were compared across both groups.Results Both groups successfully underwent surgery without encountering severe intraoperative complications.The follow-up duration for patients ranged from 12 to 24 months,with a mean of(19.2±4.3)months for the control group and(18.6±3.3)months for the experimental group.No statistically significant difference in follow-up duration was found between the groups(P＞0.05).Furthermore,there were no significant differences between the groups in intraoperative blood loss,fluoroscopy times,postoperative drainage volume,time to weight-bearing,or hospital stay(P＞0.05).However,significant differences were observed in operation time and bone healing time(P＜0.05).Compared to preoperative measurements,both groups demonstrated significant improvements in the femorotibial angle(FTA)and medial proximal tibial angle(MPTA)at the final follow-up(P＜0.05),with no significant changes in the posterior tibial slope(PTS)or medial compartment Kellgren-Lawrence grade(P＞0.05).When comparing the two groups,only the FTA showed a statistically significant difference at the final follow-up(P＜0.05),while MPTA,PTS,and K-L grade did not.Both groups also showed significant improvements in VAS,Lysholm score,WOMAC score,IKDC score,HSS score,and ROM at the final follow-up(P＜0.05).At the final follow-up,significant differences were noted between the groups in VAS,Lysholm score,IKDC score,and knee flexion-extension ROM(P＜0.05),but not in WOMAC or HSS scores(P＞0.05).The complication rate was 6.4％in the observation group and 20.8％in the control group,with a statistically significant difference(P＜0.05).Conclusion The application of TomoFix plate fixation in MOWHTO results in shorter bone healing time and a lower complication rate,leading to satisfactory outcomes,reduced long-term pain,and significant improvement in knee function.
万方数据
维普
