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内侧开放楔形胫骨高位截骨术和关节镜下半月板中央化治疗膝内翻畸形伴内侧半月板突出患者的两年随访。

Two years follow-up of patients with knee varus deformity and medial meniscus extrusion after medial opening wedge high tibial osteotomy and arthroscopic meniscus centralization.

机构信息

Jiading Branch of Shanghai General Hospital, Jiading District Jiangqiao Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Int Orthop. 2024 Feb;48(2):481-486. doi: 10.1007/s00264-023-05959-8. Epub 2023 Sep 19.

DOI:10.1007/s00264-023-05959-8
PMID:37725151
Abstract

PURPOSE

This is a retrospective study and aims to investigate the clinical outcomes of patients with knee varus deformity and extruded medial meniscus who underwent arthroscopic meniscus centralization and medial opening wedge high tibial osteotomy.

METHODS

A total of 24 patients were included in the trial, and arthroscopy intraoperative photographs and standing preoperative and postoperative radiographs were taken to analyze the mechanical tibiofemoral angle and tibial plateau inclination. Postoperative complications and knee motion were recorded, and the surgical results were evaluated using the knee society score.

RESULTS

The study observed four cases of surgery-related complications among all patients, but no major complications were reported. The surgery significantly improved knee flexion degrees and total knee range of motion. Satisfactory outcomes were shown in postoperative radiographs and secondary intraoperative photographs. The knee score increased from 39.6 ± 10.0 to 80.1 ± 9.0, and the functional score improved from 48.1 ± 6.9 to 89.4 ± 5.5. The preoperative tibial plateau inclination was 5.3 ± 0.7, while the postoperative data showed a decrease to 4.2 ± 0.7. The preoperative mechanical tibiofemoral angle was - 7.7 ± 1.0, and it improved in all patients postoperatively to 2.8 ± 0.9.

CONCLUSION

By alternating the knee biomechanics and significantly improving symptoms and quality of life, arthroscopic medial meniscus centralization and medial open wedge high tibial osteotomy units are confirmed to be an effective alternative treatment for knee varus deformity.

摘要

目的

本研究为回顾性研究,旨在探讨关节镜下半月板中央固定术联合内侧开放楔形胫骨高位截骨术治疗膝内翻畸形伴内侧半月板挤岀患者的临床疗效。

方法

本研究共纳入 24 例患者,术中拍摄关节镜下照片,术前及术后拍摄站立位 X 线片,分析机械胫股角和胫骨平台倾斜度。记录术后并发症和膝关节运动情况,采用膝关节学会评分评估手术效果。

结果

所有患者中观察到 4 例与手术相关的并发症,但均无重大并发症。手术显著改善了膝关节的屈曲度和膝关节总活动度。术后 X 线片和二次术中照片显示满意的结果。膝关节评分从 39.6±10.0 分提高到 80.1±9.0 分,功能评分从 48.1±6.9 分提高到 89.4±5.5 分。术前胫骨平台倾斜度为 5.3±0.7,术后数据显示下降至 4.2±0.7。术前机械胫股角为-7.7±1.0,所有患者术后均改善至 2.8±0.9。

结论

通过改变膝关节生物力学,明显改善症状和生活质量,证实关节镜下内侧半月板中央固定术联合内侧开放楔形胫骨高位截骨术单元是治疗膝内翻畸形的有效替代方法。

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引用本文的文献

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J Orthop. 2025 Feb 12;68:121-130. doi: 10.1016/j.jor.2025.01.036. eCollection 2025 Oct.
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Centralization reduces meniscal extrusion, improves joint mechanics and functional outcomes in patients undergoing meniscus surgery: A systematic review and meta-analysis.集中化减少半月板挤出,改善半月板手术患者的关节力学和功能结果:一项系统评价和荟萃分析。
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):888-906. doi: 10.1002/ksa.12410. Epub 2024 Aug 9.
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本文引用的文献

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Meniscal Extrusion: Diagnosis, Etiology, and Treatment Options.半月板挤出:诊断、病因及治疗选择
Curr Rev Musculoskelet Med. 2023 Jul;16(7):316-327. doi: 10.1007/s12178-023-09840-4. Epub 2023 May 16.
2
A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy: a cadaveric study.内侧截骨起点较低可增加开放楔形高位胫骨截骨术中的后倾坡度:一项尸体研究
J Exp Orthop. 2022 Dec 29;9(1):124. doi: 10.1186/s40634-022-00562-z.
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Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy.
Review of the Development of Meniscus Centralization.
半月板中心化发展综述
Curr Rev Musculoskelet Med. 2024 Aug;17(8):303-312. doi: 10.1007/s12178-024-09905-y. Epub 2024 May 17.
内侧开口楔形高位胫骨截骨术后连续MRI检查发现的半月板及软骨变化
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Short-Term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients.高胫骨截骨术治疗骨关节炎患者中立对线结合关节镜下内侧半月板中心化的短期疗效。
J Knee Surg. 2023 Feb;36(3):261-268. doi: 10.1055/s-0041-1731738. Epub 2021 Jul 14.
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Medial compartment osteoarthritis of the knee: a review of surgical options.膝关节内侧间室骨关节炎:手术选择综述
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Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review.高胫骨截骨术治疗膝骨关节炎的研究进展:系统评价。
Syst Rev. 2021 Feb 14;10(1):56. doi: 10.1186/s13643-021-01601-z.
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