Hernigou P, Ma W
Hopital Henri Mondor, 51 Avenue du Mal Lattrede, Tassigny, 94010 Creteil, France.
Knee. 2001 Jun;8(2):103-10. doi: 10.1016/s0968-0160(00)00061-2.
We studied the results of 245 valgus producing high tibial osteotomies performed with the use of an opening wedge technique and rigid internal fixation followed by early passive and active motion of the knee. Previous studies have used iliac bone grafts or hemicollastasis held by an external fixator for opening the osteotomy. In our series the opening was obtained by a block of cement interposed in the postero-medial part of the osteotomy. This series confirms that the opening wedge osteotomy allows good accuracy for the correction. Ninety-three percent of the knees had a correction adjusted between 180 and 187 degrees for the hip-knee-ankle angle. Survivorship analysis showed an expected rate of survival, with conversion to a total knee on the end point, of 94% at 5 years, 85% at 10 years and 68% at 15 years. Conversion to a total knee arthroplasty was accomplished without difficulty in the patients who had this procedure done. We recommend opening wedge tibial osteotomy with acrylic cement bone cement as bone substitute, rigid internal fixation, and early motion for patients who undergo high tibial osteotomy.
我们研究了采用开口楔形技术和坚强内固定并随后进行膝关节早期被动及主动活动的245例外翻型高位胫骨截骨术的结果。既往研究使用髂骨移植或通过外固定器保持半骺阻滞来进行截骨开口。在我们的系列研究中，截骨开口是通过在截骨后内侧部位置入一块骨水泥来实现的。该系列研究证实开口楔形截骨术可实现良好的矫正精度。93%的膝关节髋-膝-踝角矫正角度在180°至187°之间。生存分析显示预期生存率，以全膝关节置换作为终点，5年时为94%，10年时为85%，15年时为68%。接受该手术的患者向全膝关节置换的转换过程并无困难。我们推荐对于接受高位胫骨截骨术的患者采用丙烯酸骨水泥作为骨替代物的开口楔形胫骨截骨术、坚强内固定及早期活动。
