Brouwer R W, Verhaar J A N
Erasmus Medisch Centrum, afd. Orthopedie, Rotterdam.
Ned Tijdschr Geneeskd. 2004 Oct 2;148(40):1955-60.
Young patients with gonarthrosis that does not respond adequately to conservative therapy can be treated by corrective osteotomy. Osteoarthritis of one compartment more often has a mechanical aetiology than osteoarthritis of the entire knee. Patients with osteoarthritis of the medial compartment often have a genu varum (bow-legs) while patients with osteoarthritis of the lateral compartment often have a genu valgum (knock-knees). The goal of corrective osteotomy is to transfer the load bearing to the normal compartment, which will reduce the symptoms and permit arthroplasty to be postponed. In retrospective studies, the procedure resulted in less pain, improved knee function or postponement of knee arthroplasty in 28-87% of the patients. Possible complications include pseudarthrosis, thromboembolism, contracture of the patellar tendon, paresis of the N. peroneus, compartment syndrome. The outcome of osteotomy for gonarthrosis depends on careful patient selection, the stage of osteoarthritis, and the achievement and maintenance of the correction of the load axis that was calculated before the operation.
对于保守治疗反应欠佳的年轻膝关节炎患者，可采用矫正截骨术进行治疗。单髁骨关节炎往往比全膝关节骨关节炎更常由机械因素引起。内侧间室骨关节炎患者常出现膝内翻（弓形腿），而外侧间室骨关节炎患者常出现膝外翻（膝外翻）。矫正截骨术的目的是将负重转移至正常间室，这将减轻症状并使关节置换术得以推迟。在回顾性研究中，该手术使28%至87%的患者疼痛减轻、膝关节功能改善或膝关节置换术推迟。可能的并发症包括假关节形成、血栓栓塞、髌腱挛缩、腓总神经麻痹、骨筋膜室综合征。膝关节炎截骨术的疗效取决于仔细的患者选择、骨关节炎的阶段以及术前计算的负重轴矫正的实现和维持情况。
