Nourbakhsh Mohsen, Motififard Mehdi, Shemshaki Hamidreza, Etemadifar Mohammad reza, Zarezade Abolghasem, Farajzadegan Ziba, Mazoochian Farhad
Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Med Arh. 2012;66(1):58-60. doi: 10.5455/medarh.2012.66.58-60.
Tibial proximal osteotomy is one of the treatments for patients with knee compartment osteoarthritis. Studies showed 80% good prognosis in five years follow up after osteotomy. Almost always this method is used for pure medial knee compartment osteoarthritis that has a varus deformity. THE AIM of all methods is reforming varus deformity and lower limb alignment to gain 3 to 5 degree extra reformation and take knee in 10 degree valgus. One of the main etiologies for patients inconvenience and no decreasing in their pain is overcorrection or undercorrection, but unfortunately these can't be noticed. Therefore we must make sure that additional stress on the medial joint line was eliminated and regeneration of cartilage was facilitated or at least occurrence of osteochondritis was decreased. So we aimed to determine the efficacy of tibial proximal osteotomy in lower limb alignment indexes in patients with osteoarthritis in medial compartment of knee.
This study is a clinical trial study that has done in Alzahra University Hospital of Isfahan Medical Science University in Iran since June 2010 till February in 2011. Patients had pain, pure medial knee compartment osteoarthritis and varus deformities were determined for study. Patients who wouldn't come for control, those who had no convenience for giving their data or osteoarthritis of all three compartments were excluded from study. Number of patients has determined 40 persons according to previous studies. Sampling occurred convenient. Before any surgical processes, the AP x-ray radiography was applied for alignment view. The demographic and radiographic data was registered. Six months later we applied AP x-ray radiography again and obtained data and analysis them with SPSS software and T-Paired statistical method.
The mean of anatomical limb angle before and after surgical process were 5.1 +/- 3.4 varus and 11.9 +/- 3.4 degree valgus, respectively,so with T-test there was a significant difference between them (P < 0.001). The mean of mechanical limb angle before and after surgical process were 12.6 +/- 3.4 varus and 4.75 +/- 3.5 degree valgus, respectively. Therefor with T-test, there was significant difference between them (P < 0.001).
Results were achieved from this study showed that Tibial proximal osteotomy is appropriate treatment for young and middle age patients with progressive deformity, symptomatic varus knee. Key words: Tibial proximal osteotomy, Knee, Osteoarthritis, Varus deformity.
胫骨近端截骨术是治疗膝关节单间室骨关节炎患者的方法之一。研究表明，截骨术后五年随访的良好预后率为80%。几乎总是将这种方法用于患有内翻畸形的单纯内侧膝关节单间室骨关节炎。所有方法的目的都是矫正内翻畸形和下肢力线，以获得3至5度的额外矫正，并使膝关节达到10度外翻。患者不便和疼痛未减轻的主要病因之一是矫正过度或不足，但不幸的是这些情况无法被察觉。因此，我们必须确保消除内侧关节线的额外压力，促进软骨再生或至少减少骨软骨炎的发生。因此，我们旨在确定胫骨近端截骨术对膝关节内侧间室骨关节炎患者下肢力线指标的疗效。
本研究是一项临床试验研究，于2010年6月至2011年2月在伊朗伊斯法罕医科大学阿尔扎赫拉大学医院进行。确定有疼痛、单纯内侧膝关节单间室骨关节炎和内翻畸形的患者进行研究。不来进行对照的患者、不方便提供数据的患者或三个间室均患骨关节炎的患者被排除在研究之外。根据以往研究确定患者人数为40人。采用方便抽样。在任何手术操作之前，应用前后位X线摄影进行力线观察。记录人口统计学和影像学数据。六个月后再次应用前后位X线摄影，获取数据并用SPSS软件和配对t统计方法进行分析。
手术前后解剖学下肢角度的平均值分别为5.1±3.4度内翻和11.9±3.4度外翻，因此通过t检验，两者之间存在显著差异（P<0.001）。手术前后力学下肢角度的平均值分别为12.6±3.4度内翻和4.75±3.5度外翻。因此通过t检验，两者之间存在显著差异（P<0.001）。
本研究结果表明，胫骨近端截骨术是治疗年轻和中年进行性畸形、有症状内翻膝关节患者的合适方法。关键词：胫骨近端截骨术；膝关节；骨关节炎；内翻畸形
