胫骨高位截骨术治疗膝内翻伴膝外摆步态的疗效与不足.doc

《胫骨高位截骨术治疗膝内翻伴膝外摆步态的疗效与不足.doc》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、胫骨高位截骨术治疗膝内翻伴膝外摆步态的疗效与不足作者：王飞，陈竞清，陈百成，高石军，邵德成，李彤【关键词】胫骨近端摘要：［目的］探讨外侧闭合胫骨高位截骨术治疗膝内翻伴膝外摆步态患者的临床效果及相关的影响因素。［方法］随访2000～2004年因膝内翻伴膝外摆步态于本院行胫骨高位截骨手术的患者19例，年龄47～54岁，随访时间6个月～4a。术前及术后X线片测量股骨-胫骨角、胫骨平台后倾角和腓骨小头高度，HSS膝关节功能评分，关节后外侧稳定性测试，术后患者以五点问卷法评价术后关节稳定性的改善情况。［结果］股骨-胫骨角术前

2、1845°～197°，术后167°～176°；腓骨小头高度术前773～185mm，术后-35～107mm；胫骨后倾角术前2°～17°，术后-4°～13°；HSS评分术前48～68分，术后60～91分（P=000）。后外侧的稳定性测量术前Ⅰ度损伤16例，Ⅱ度损伤3例。术后Ⅰ度损伤9例，Ⅱ度损伤10例（P＜005）。术后患者关节稳定性的问卷4例明显提高，9例有提高，6例与术前相同。［结论］外侧闭合胫骨高位截骨治疗膝内翻合并膝外摆的近期效果良好，远期效果可能受到膝外摆步态、胫骨后倾角和腓骨小头高度改变的影响。关键词：膝关

3、节；内翻；胫骨近端；截骨；关节不稳；膝外摆Abstract：［Objective］Toassessthefunctionaloutcome,influencefactorsanditsmanagementoflateralwedgehightibialosteotomy（HTO）inpatientswithsymptomaticlateralthrustandvarusmalalignment［Method］Theresultsof19lateralclosingwedgeHTOsinpatientswithasy

4、mptomatichyperextensionvarusthrustwereevaluatedfrom2000to2004Theaverageageofthepatientsatthetimeofsurgerywas49years（ranged,47~54years）Radiographswereanalyzedtocomparechangesinfemorotibialangle,tibialslope,andtheheightofthefibularheadpreandpostoperativelyFuncti

5、onalresultswereevaluatedaccordingtothescoringsystemofHSSThevarusstresstestwasusedtoevaluatedtheposterolateralkneeinjuryWeuseda5pointvisualanaloguescaletoassesschangeinkneestability［Result］Patientswerefollowedforanaverageof21monthsFemorotibialaxisalignmentwas18

6、45°～197°preoperativelyand167°～176°postoperatively;Posteriortibialslopewas2°～17°preoperativelyand-4°～13°postoperatively;Theheightoffibularheadwas77～185mmpreoperativelyand-35～107mmpostoperatively（P=000）AllpatientshadanincreaseintheirHSSscorepostoperativelySixtee

7、npatientshadGrade1posterolateralinjuriesand3patientshadGrade2injurespreoperatively,9patientshadGrades1injuresand10patientshadGrade2injures（P＜005）Fourpatients5ratedtheirkneestabilityasbeingsignificantlybetter,nineasbeingbetterandsixasbeingsame［Conclusion］Latera

8、lclosingwedgeHTOcanproducegoodfunctionalandadiographicresultinpatientswithsymptomaticlateralthrustandvarusmalalignmentintheshortterm,buttheseresultsprobablydeterioratewithtimeLater