[膝关节不稳与内翻畸形——同时进行交叉韧带重建和截骨术（适应症、规划与手术技术、结果）]

[Knee instability and varus malangulation - Simultaneous cruciate ligament reconstruction and osteotomy (Indication, planning and operative technique, results)].

作者信息

Aqueskirchner J D, Bernau A, Burkart A C, Imhoff A B

机构信息

Abteilung und Poliklinik für Sportorthopädie der Technischen Universität München, Germany.

出版信息

Z Orthop Ihre Grenzgeb. 2002 Mar-Apr;140(2):185-93. doi: 10.1055/s-2002-31539.

DOI:10.1055/s-2002-31539

PMID:12029592

Abstract

AIM

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malangulated knees. We present the indication, planning of the osteotomy as well as the operative technique and the results of our patients with simultaneous osteotomy and cruciate ligament reconstruction.

MATERIALS/METHODS: From 4/96 until 12/00 58 patients ( 33 years) received simultaneous osteotomy (r = 57 correcting valgus, r = 1 varus malalignement) and cruciate ligament plasty (e = 49 ACL, n = 7 PCL, n = 2 ACL & PCL which routinely was performed in the arthroscopic technique after completion of the osteotomy (closed-wedge technique). Average correction angle of the osteotomy was 7 (4 - 10) degrees with a mean malalignement of 5 (0 - 10) degrees. 13 patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), 2 patients received an implanted Collagen Meniscus (CMI) at the same time.

RESULTS

Preoperatively the Lysholm score was 66 (35 - 81) points and increased to 81 (74 - 95), 87 (79 - 99) and 93 (88 - 99) points at 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in 4 patients.

CONCLUSIONS

Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost effective therapy delaying the progression of osteoarthritis and minimising clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and return of these patients to the activities of daily living and sports.

摘要

目的

年轻患者的骨软骨损伤和骨关节炎常由膝内翻畸形膝关节的慢性不稳定引起。我们介绍了截骨术的适应证、手术规划、手术技术以及同期进行截骨术和交叉韧带重建患者的治疗结果。

材料/方法：从1996年4月至2000年12月，58例患者（平均年龄33岁）同期接受了截骨术（57例矫正外翻，1例矫正内翻畸形）和交叉韧带成形术（49例前交叉韧带，7例后交叉韧带，2例前后交叉韧带），截骨术常规在关节镜技术下完成截骨后进行（闭合楔形截骨技术）。截骨术的平均矫正角度为7（4 - 10）度，平均畸形为5（0 - 10）度。13例患者接受了额外的软骨手术（自体骨软骨移植、自体软骨细胞移植、微骨折术），2例患者同时植入了胶原蛋白半月板（CMI）。