Qing Zhong, Ye Jiumin, Ma Jianbing, Li Hui, Wang Zhiyuan
Knee Ward of Joint Surgery Department, Honghui Hospital, Xi'an Jiao Tong University, Xi'an Shaanxi, 710054,
No.1 Department of Anesthesia, Honghui Hospital, Xi'an Jiao Tong University, Xi'an Shaanxi, 710054, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jun 15;31(6):659-664. doi: 10.7507/1002-1892.201701037.
To evaluate the effects of the improved precision alignment method of lower limbs mecha-nical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).
A retrospective analysis was made on the clinical data of 62 patients (68 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between January 2012 and December 2015 who accorded with the inclusion criteria. The traditional method for positioning lower limb mechanical force line was used in 29 cases (32 knees) (traditional group), and improved method for positioning lower limb mechanical force line in 33 cases (36 knees) (modified group). There was no significant difference in gender, age, side, course of disease, and osteoarthritis grading between two groups ( >0.05) with comparable. The operation time, intraoperative fluoroscopy times, and intraoperative blood loss were recorded in two groups; Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC).
Incision hematoma occurred in 1 case of traditional group and was cured at 3 weeks after symptomatic treatment; and primary healing was obtained in the other patients, with no early complications. The operation time and intraoperative fluoroscopy times of the modified group were significantly lower than those of the traditional group ( =11.934, =0.000; =11.663, =0.000), but there was no significant difference in blood loss between the two groups ( =0.209, =0.835). The patients were followed up for 6 to 24 months (mean, 12.7 months) in the traditional group and for 3 to 22 months (mean, 13.2 months) in the modified group. The medial knee pain disappeared in all patients. At last follow-up, the HSS score and WOMAC score were significantly improved when compared with preoperative scores in two groups ( <0.05), but there was no significant difference between the two groups ( >0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at immediate after operation and last follow-up was significantly higher than angle at pre-operation in two groups ( <0.05), but there was no significant difference between at immediate after operation and at last follow-up ( >0.05).
Compared with the traditional method for positioning lower limb mechanical force line, the improved precision alignment method can reduce the times of intraoperative fluoroscopy and shorten the operation time, which reduces the radiation exposure of both doctors and patients.
评估改良下肢机械对线精准度方法在开放性楔形高位胫骨截骨术（OWHTO）治疗膝关节骨关节炎中的效果。
回顾性分析2012年1月至2015年12月间62例（68膝）符合纳入标准的内侧间室膝关节骨关节炎患者行OWHTO治疗的临床资料。29例（32膝）采用传统下肢机械力线定位方法（传统组），33例（36膝）采用改良下肢机械力线定位方法（改良组）。两组患者在性别、年龄、患侧、病程及骨关节炎分级方面差异无统计学意义（P>0.05），具有可比性。记录两组患者的手术时间、术中透视次数及术中出血量；术前、术后在X线片上观察下肢机械力线，以髋-膝-踝角（HKA）表示。采用美国特种外科医院（HSS）评分及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评估临床疗效。
传统组1例出现切口血肿，经对症处理3周后治愈；其余患者均一期愈合，无早期并发症。改良组手术时间及术中透视次数显著低于传统组（P=11.934，P=0.000；P=11.663，P=0.000），但两组出血量差异无统计学意义（P=0.209，P=0.835）。传统组患者随访6至24个月（平均12.7个月），改良组随访3至22个月（平均13.2个月）。所有患者膝关节内侧疼痛均消失。末次随访时，两组HSS评分及WOMAC评分较术前均显著改善（P<0.05），但两组间差异无统计学意义（P>0.05）。术后X线检查显示两组胫股角均得到矫正。两组术后即刻及末次随访时的HKA角均显著高于术前（P<0.05），但术后即刻与末次随访时差异无统计学意义（P>0.05）。
与传统下肢机械力线定位方法相比，改良的精准对线方法可减少术中透视次数，缩短手术时间，从而减少医生和患者的辐射暴露。
