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胫腓骨近端截骨外固定架治疗膝内侧骨性关节炎

Proximal tibiofibular osteotomy with external fixator for medial knee osteoarthritis

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[目的]介绍胫腓骨近端截骨外固定架治疗膝内侧骨性关节炎的手术技术和初步临床结果.[方法]2018年4月-2021年12月采用上述方法治疗10例膝关节内侧间室骨关节炎患者,根据术前双下肢站立位全长X线片确定截骨部位,沿腓骨头下方约3cm纵行切口,自腓骨长短肌及腓肠肌之间间隙进入,两孔截骨器截除1cm腓骨;同法于胫骨结节下方截断胫骨,根据患者小腿直径选择合适固定环,安装Ilizarov外固定架,截骨远近端环应用贯穿克氏针和螺纹针固定,术后7 d逐步调整外架矫正畸形.[结果]所有患者顺利完成手术,术中无血管神经损伤,所有患者外固定架在术后21 d内调整完毕,继续佩戴外固定架维持矫正,佩戴外固定架时间平均(101.9±9.5)d,下肢力线达到满意矫正.随访时间平均(2.0±0.6)年,末次随访时疼痛 VAS、KSS 评分、下肢机械轴偏移(mechanical axis deviation,MAD)、胫骨近端内侧角(medial proximal tibial angle,MPTA)均较术前显著改善(P<0.05).[结论]胫腓骨近端截骨矫形结合环形外固定架治疗膝关节内侧间室骨关节炎可明显矫正畸形,取得满意效果.
[Objective]To introduce the surgical technique and preliminary clinical results of proximal tibiofibular osteotomy with exter-nal fixator for medial knee osteoarthritis.[Methods]From April 2018 to December 2021,10 patients with medial knee osteoarthritis were treated with the above method.The osteotomy site was determined according to the preoperative full-length X-ray film of both lower limbs.An incision was made about 3cm below the head of the fibula to remove a fibular segment 1 cm in length after drilling and osteotomy through the intermuscular space between the peroneus longus,brevis and the gastrocnemius.After that,the tibial osteotomy below the tibial tubercle was conducted in the same way,and a suitable fixation ring was selected according to the diameter of the patient's lower leg,and an Ilizarov's external frame was installed.The external frame with rings above and below the osteotomy sites fixed with Kirshner wires and threaded pins was gradually adjusted beginning 7 days after surgery to correct the deformity.[Results]All patients had operation performed successfully without vascular and nerve injury during the operation,with the external fixator to be continued adjust to correct the deformity within 21 days after the operation.The patients wore the external fixator for(101.9±9.5)days in a mean,and got the alignment of lower limb force satisfacto-rily corrected.At the latest follow-up lasted for(2.0±0.6)years,the VAS for pain,KSS score,mechanical axis deviation(MAD)of lower ex-tremity,and medial proximal tibial angle(MPTA)significantly improved in the patients(P<0.05).[Conclusion]Proximal tibiofibular osteot-omy with Ilizarov's external fixator for medial knee osteoarthritis does correct the deformity effectively,and achieves satisfactory clinical con-sequences.

tibial osteotomyfibular osteotomymedial knee osteoarthritisIlizarov technique

王振军、许红生、焦绍锋、张海涛、刘志杰、郭悦、陈建文

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国家康复辅具研究中心附属康复医院,北京 100176

南方科技大学医院,广东深圳 518000

胫骨截骨术 腓骨截骨术 膝内侧骨性关节炎 Ilizarov技术

北京市科委首都临床特色应用研究项目

Z181100001718194

2024

中国矫形外科杂志
中国残疾人康复协会 中国人民解放军第八十八医院

中国矫形外科杂志

CSTPCD北大核心
影响因子:1.521
ISSN:1005-8478
年,卷(期):2024.32(1)
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