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关节镜联合双平面胫骨高位截骨治疗前交叉韧带损伤伴下肢力线不良的早期疗效

The clinical efficacy of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint

摘要:

目的:探讨关节镜联合双平面胫骨高位截骨治疗伴下肢力线不良的前交叉韧带损伤患者的早期效果。方法:回顾性分析2017年1月至2018年6月于西南医科大学附属医院行关节镜联合双平面胫骨高位截骨治疗的17例(17膝)前交叉韧带损伤伴下肢力线不良的患者资料。其中男性11例,女性6例,年龄41.3岁(范围:32~49岁)。所有患者采用关节镜联合双平面胫骨高位截骨术治疗,术中行内侧撑开胫骨高位截骨,膝关节冠状面调整下肢力线通过Fujisawa点(胫骨平台由内向外的62.5%处),矢状面调整胫骨平台后倾角至正常范围,然后行关节镜下前交叉韧带重建。患者均于手术前、后行下肢负重位全长X线检查,并测量下肢机械轴通过胫骨平台的相对位置、股胫角和胫骨平台后倾角。采用Lysholm评分、美国特种外科医院评分、Tegner膝关节运动评分和国际膝关节评分委员会评分评价膝关节功能,并通过Lachman试验、KT-1000侧-侧差值和轴移试验评价膝关节前后及旋转稳定性。手术前后各指标的比较采用配对样本 t检验。 结果:17例患者均获随访,随访时间1.8年(范围:1.2~2.5年),未发现感染、下肢深静脉血栓形成、移植物失效、骨不愈合或延迟愈合等并发症。下肢机械轴通过胫骨平台的相对位置由术前的(28.48±2.24)%改善至术后的(57.43±1.02)%( t=46.80, P=0.00),股胫角由术前的(172.31±3.37)°改善至术后的(178.91±1.34)°( t=10.46, P=0.00);术前胫骨平台后倾角由术前的(14.29±1.26)°改善至术后的(9.31±0.79)°( t=24.59, P=0.00);KT-1000侧-侧差值由术前的(7.95±1.19)mm改善为术后的(1.79±0.49)mm( t=18.34, P=0.00);末次随访时,患者Lysholm评分、美国特种外科医院评分、Tegner膝关节运动评分、国际膝关节文献委员会评分均较术前改善,差异有统计学意义( P值均<0.05)。 结论:关节镜联合双平面胫骨高位截骨治疗伴下肢力线不良的前交叉韧带损伤,能有效改善下肢力线和膝关节稳定性,早期临床效果满意。

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abstracts:

Objective:To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint.Methods:A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability.Results:The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively ( t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively( t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively ( t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively( t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative( P<0.05). Conclusion:Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.

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