Patond K R, Lokhande A V
Department of Orthopaedics, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
Natl Med J India. 1993 May-Jun;6(3):104-8.
For osteoarthrosis of the knee unresponsive to medical treatment, the standard operative technique is to remove a wedge of the knee from the lateral aspect of the tibia. We describe a simple and precise procedure--medial open wedge high tibial osteotomy.
Between 1988 and 1991, we performed 25 medial open wedge high tibial osteotomies for osteoarthrosis of the medial compartment of the knee with varus deformity. Anterior tibial tubercle elevation (ventralization) was combined with the index procedure in 6 cases which were associated with patellofemoral arthrosis. To keep the osteotomy open a bicortical wedge-shaped graft from the iliac crest was used in 14 cases and from the tibia in 8 cases. Osteotomy was performed 2 cm distal to the articular surface of the tibia above the tibial tuberosity. Fixation of the osteotomy was not required.
Twenty-two patients were available for follow up examination and were assessed clinically and radiologically over a period ranging from 6 to 48 months (mean 22 months). Fourteen of them did well and 8 had fair results. No major complications were encountered.
Medial open wedge high tibial osteotomy not only has results comparable to other techniques but has several advantages of being a simple and accurate procedure with a low morbidity.
对于药物治疗无效的膝关节骨关节炎，标准手术技术是从胫骨外侧切除一块楔形骨块。我们描述一种简单且精确的手术——内侧开放性楔形高位胫骨截骨术。
1988年至1991年间，我们对25例伴有内翻畸形的膝关节内侧间室骨关节炎患者施行了内侧开放性楔形高位胫骨截骨术。6例合并髌股关节病的患者在该手术基础上联合进行了胫骨结节抬高术（前移）。为保持截骨处张开，14例使用取自髂嵴的双皮质楔形骨块，8例使用取自胫骨的骨块。截骨部位在胫骨结节上方胫骨关节面远端2厘米处。无需对截骨处进行固定。
22例患者接受了随访检查，在6至48个月（平均22个月）期间进行了临床和影像学评估。其中14例效果良好，8例效果尚可。未出现重大并发症。
内侧开放性楔形高位胫骨截骨术不仅效果与其他技术相当，而且具有操作简单、精确且发病率低等诸多优点。
