胫骨高位截骨术研究进展
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摘要
胫骨高位截骨术(HTO)是治疗膝关节骨关节炎有效的手术方式之一,它主要通过改变下肢力线,将应力转移至外侧间室,从而降低内侧间室压力,缓解膝关节疼痛不适,保留膝关节原有结构,临床疗效肯定。本文综述了HTO手术适应证、禁忌证、矫形机制、手术技术、固定方式以及术后康复和生存率的研究进展。
High tibial osteotomy(HTO) is one of the effective surgical options for knee osteoarthritis. It mainly transfers stress to the lateral compartment by changing the force line of the lower limbs, thus reducing the pressure of the medial compartment, alleviating pain and discomfort of the knee joint, and retaining the original structure of the knee joint. Its clinical efficacy is ascertained. This article reviewed the research progress of HTO in the respects of indications, contraindications, orthopedic mechanism, surgical techniques, fixation methods, post-operative rehabilitation, and survival rate.
High tibial osteotomy(HTO) is one of the effective surgical options for knee osteoarthritis. It mainly transfers stress to the lateral compartment by changing the force line of the lower limbs, thus reducing the pressure of the medial compartment, alleviating pain and discomfort of the knee joint, and retaining the original structure of the knee joint. Its clinical efficacy is ascertained. This article reviewed the research progress of HTO in the respects of indications, contraindications, orthopedic mechanism, surgical techniques, fixation methods, post-operative rehabilitation, and survival rate.
引文
[1] Coventry MB.Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee[J].J Bone Joint Surg Am,2001,83(9):1426.
[2] Coventry MB.Osteotomy about the knee for degenerative and rheumatoid arthritis[J].J Bone Joint Surg Am,1973,55(1):23-48.
[3] Akamatsu Y,Koshino T,Saito T,et al.Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy[J].Clin Orthop Relat Res,1997,334(334):207-214.DOI:10.1097/000 03086-199701000-00027.
[4] Jung WH,Takeuchi R,Chun CW,et al.Second-look arthroscopic assessment of cartilage regeneration after medial open-wedge high tibial osteotomy[J].Arthroscopy,2014,30(1):72-79.DOI:10.1016/j.arthro.2013.10.008.
[5] 陈伟,陈百成,王飞,等.应用不同方法治疗膝关节骨性关节炎的对比研究[J].河北医科大学学报,2015,36(5):600-602.DOI:10.3969/j.issn.1007-3205.2015.05.036.Chen W,Chen BC,Wang F,et al.Comparative study of different treatment methods of knee osteoarthritis[J].J Hebei Med Univ,2015,36(5):600-602.DOI:10.3969/j.issn.1007-3205.2015.05.036.
[6] 董晨,苏云星.膝关节骨关节炎的手术治疗[J].中国药物与临床,2017,17(3):368-370.Dong C,Su YX.Surgical treatment of knee osteoarthritis[J].Chin Rem Clin,2017,17(3):368-370.
[7] Spahn G,Hofmann GO,von Engelhardt LV,et al.The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis:a meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2013,21(1):96-112.DOI:10.1007/s00167-011-1751-2.
[8] Nwachukwu BU,McCormick FM,Schairer WW,et al.Unicom-partmental knee arthroplasty versus high tibial osteotomy:united states practice patterns for the surgical treatment of unicompartmental arthritis[J].J Arthroplasty,2014,29(8):1586-1589.DOI:10.1016/j.arth.2014.04.002.
[9] 张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究[J].河北医科大学学报,2014,35(2):218-219.DOI:10.3969/j.issn.1007-3205.2014.02.037.Zhang YZ,Li CX,Li JD,et al.Study on the mechanism of uneven settlement in knee joint degeneration and varus[J].J Hebei Med Univ,2014,35(2):218-219.DOI:10.3969/j.issn.1007-3 205.2014.02.037.
[10] Amendola A,Bonasia DE.Results of high tibial osteotomy:review of the literature[J].Int Orthop,2010,34(2):155-160.DOI:10.1007/s00264-009-0889-8.
[11] Bonnin M,Chambat P.Current status of valgus angle,tibial head closing wedge osteotomy in media gonarthrosis[J].Orthopade,2004,33(2):135-142.DOI:10.1007/S00132-003-0586-Z.
[12] Niemeyer P,Schmal H,Hauschild O,et al.Open-wedge osteo-tomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment:3-year results with regard to preoperative arthroscopic and radiographic findings[J].Arthroscopy,2010,26(12):1607-1616.DOI:10.1016/j.arthro.2010.05.006.
[13] Billings A,Scott DF,Camargo MP,et al.High tibial osteotomy with a calibrated osteotomy guide,rigid internal fixation,and early motion:long-term follow-up[J].J Bone Joint Surg Am,2000,82(1):70-79.
[14] Runkel M,Rommens PM.Pseudoarthrosis[J].Unfallchirurg,2000,103(1):51-63.
[15] Rodriguez-Merchan EC,Forriol F.Nonunion:general principles and experimental data[J].Clin Orthop Relat Res,2004,419:4-12.
[16] Miller BS,Downie B,McDonough EB,et al.Complications after medial open-wedge high tibial osteotomy[J].Arthroscopy,2009,25(6):639-646.DOI:10.1016/j.arthro.2008.12.020.
[17] Aryee S,Imhoff AB,Rose T,et al.Do we need synthetic osteotomy augmentation materials for open-wedge high tibial osteotomy[J].Biomaterials,2008,29(26):3497-3502.DOI:10.101 6/j.biomaterials.2008.05.027.
[18] Tetsworth K,Paley D.Malalignment and degenerative arthro-pathy[J].Orthop Clin North Am,1994,25(3):367-377.
[19] Fujisawa Y,Masuhara K,Shiomi S.The effect of high tibial osteotomy on osteoarthritis of the knee:an arthroscopic study of 54 knee joints[J].Orthop Clin North Am,1979,10(3):585-608.
[20] Iorio R,Healy WL.Unicompartmental arthritis of the knee[J].J Bone Joint Surg Am,2003,85(7):1351-1364.
[21] 时剑辉,吕伟,王岩,等.3D打印截骨切模辅助胫骨高位截骨术治疗伴有骨关节炎的膝内翻畸形[J].中国卫生标准管理,2018,9(2):56-57.DOI:10.3969/j.issn.1674-9316.2018.02.0 29.Shi JH,Lyu W,Wang Y,et al.The high tibial osteotomy aided by three-dimensional (3D) printing cutting block for correction of genu varum with osteoarthritis[J].Chin Health Stand Manage,2018,9(2):56-57.DOI:10.3969/j.issn.1674-9316.2018.02.029.
[22] Müller M,Strecker W.Arthroscopy prior to osteotomy around the knee[J].Arch Orthop Trauma Surg,2008,128(11):1217-1221.DOI:10.1007/s00402-007-0398-4.
[23] Adili A,Bhandari M,Giffin R,et al.Valgus high tibial osteotomy.Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee[J].Knee Surg Sports Traumatol Arthrosc,2002,10(3):169-176.DOI:10.1007/s00167 -001-0250-2.
[24] 刘娜,王丙刚.胫骨结节上与结节下截骨治疗膝单间室骨关节炎对比[J].实用骨科杂志,2015,21(11):983-987.DOI:10.13795/j.cnki.sgkz.2015.11.007.Liu N,Wang BG.Treatment of early unicompartmental knee osteoarthritis with varus by high tibial osteotomy:comparison between results of high tibial osteotomy above and below tibial tubercle[J].J Pract Orthop,2015,21(11):983-987.DOI:10.13795/j.cnki.sgkz.2015.11.007.
[25] Lee DC,Byun SJ.High tibial osteotomy[J].Knee Surg Relat Res,2012,24(2):61-69.DOI:10.5792/ksrr.2012.24.2.61.
[26] Sen C,Kocaoglu M,Eralp L.The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up)[J].Knee Surg Sports Traumatol Arthrosc,2003,11(3):139-144.DOI:10.1007/s00167-003-0344-0.
[27] Dugdale TW,Noyes F,Styer D.Preoperative planning for high tibial osteotomy:the effect of lateral tibiofemoral separation and tibiofemoral length[J].Clin Orthop Relat Res,1992,274(274):248-264.DOI:10.1097/00003086-199201000-00025.
[28] Asada S,Akagi M,Mori S,et al.Increase in posterior tibial slope would result in correction loss in frontal plane after medial open-wedge high tibial osteotomy[J].Knee Surg Sports Traumatol Arthrosc,2012,20(3):571-578.DOI:10.1007/s00167-011-1610-1.
[29] Schr?ter S,Gonser CE,Konstantinidis L,et al.High complication rate after biplanar open-wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute[J].Arthroscopy,2011,27(5):644-652.DOI:10.1016/j.arthro.2011.01.008.
[30] 刘培来,卢群山.植骨在胫骨高位截骨术中的应用[J].中华关节外科杂志(电子版),2016,10(5):530-534.DOI:10.3877/cma.j.issn.1674-134X.2016.05.011.Liu PL,Lu QS.Application of bone grafting in high tibial oste-otomy[J].Chin J Joint Surg (Electron Ed),2016,10(5):530-534.DOI:10.3877/cma.j.issn.1674-134X.2016.05.0 11.
[31] Zorzi AR,da Silva HG,Muszkat C,et al.Opening-wedge high tibial osteotomy with and without bone graft[J].Artif Organs,2011,35(3):301-307.DOI:10.1111/j.1525-1594.2010.01 058.x.
[32] Luites JW,Brinkman JM,Wymenga AB,et al.Fixation stability of open- versus close-wedge high tibial osteotomy:a randomised clinical trial using radiostereometry[M].J Bone Joint Surg Br,2009,91(11):1459-1465.DOI:10.1302/0301-620X.91B11.22614.
[2] Coventry MB.Osteotomy about the knee for degenerative and rheumatoid arthritis[J].J Bone Joint Surg Am,1973,55(1):23-48.
[3] Akamatsu Y,Koshino T,Saito T,et al.Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy[J].Clin Orthop Relat Res,1997,334(334):207-214.DOI:10.1097/000 03086-199701000-00027.
[4] Jung WH,Takeuchi R,Chun CW,et al.Second-look arthroscopic assessment of cartilage regeneration after medial open-wedge high tibial osteotomy[J].Arthroscopy,2014,30(1):72-79.DOI:10.1016/j.arthro.2013.10.008.
[5] 陈伟,陈百成,王飞,等.应用不同方法治疗膝关节骨性关节炎的对比研究[J].河北医科大学学报,2015,36(5):600-602.DOI:10.3969/j.issn.1007-3205.2015.05.036.Chen W,Chen BC,Wang F,et al.Comparative study of different treatment methods of knee osteoarthritis[J].J Hebei Med Univ,2015,36(5):600-602.DOI:10.3969/j.issn.1007-3205.2015.05.036.
[6] 董晨,苏云星.膝关节骨关节炎的手术治疗[J].中国药物与临床,2017,17(3):368-370.Dong C,Su YX.Surgical treatment of knee osteoarthritis[J].Chin Rem Clin,2017,17(3):368-370.
[7] Spahn G,Hofmann GO,von Engelhardt LV,et al.The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis:a meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2013,21(1):96-112.DOI:10.1007/s00167-011-1751-2.
[8] Nwachukwu BU,McCormick FM,Schairer WW,et al.Unicom-partmental knee arthroplasty versus high tibial osteotomy:united states practice patterns for the surgical treatment of unicompartmental arthritis[J].J Arthroplasty,2014,29(8):1586-1589.DOI:10.1016/j.arth.2014.04.002.
[9] 张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究[J].河北医科大学学报,2014,35(2):218-219.DOI:10.3969/j.issn.1007-3205.2014.02.037.Zhang YZ,Li CX,Li JD,et al.Study on the mechanism of uneven settlement in knee joint degeneration and varus[J].J Hebei Med Univ,2014,35(2):218-219.DOI:10.3969/j.issn.1007-3 205.2014.02.037.
[10] Amendola A,Bonasia DE.Results of high tibial osteotomy:review of the literature[J].Int Orthop,2010,34(2):155-160.DOI:10.1007/s00264-009-0889-8.
[11] Bonnin M,Chambat P.Current status of valgus angle,tibial head closing wedge osteotomy in media gonarthrosis[J].Orthopade,2004,33(2):135-142.DOI:10.1007/S00132-003-0586-Z.
[12] Niemeyer P,Schmal H,Hauschild O,et al.Open-wedge osteo-tomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment:3-year results with regard to preoperative arthroscopic and radiographic findings[J].Arthroscopy,2010,26(12):1607-1616.DOI:10.1016/j.arthro.2010.05.006.
[13] Billings A,Scott DF,Camargo MP,et al.High tibial osteotomy with a calibrated osteotomy guide,rigid internal fixation,and early motion:long-term follow-up[J].J Bone Joint Surg Am,2000,82(1):70-79.
[14] Runkel M,Rommens PM.Pseudoarthrosis[J].Unfallchirurg,2000,103(1):51-63.
[15] Rodriguez-Merchan EC,Forriol F.Nonunion:general principles and experimental data[J].Clin Orthop Relat Res,2004,419:4-12.
[16] Miller BS,Downie B,McDonough EB,et al.Complications after medial open-wedge high tibial osteotomy[J].Arthroscopy,2009,25(6):639-646.DOI:10.1016/j.arthro.2008.12.020.
[17] Aryee S,Imhoff AB,Rose T,et al.Do we need synthetic osteotomy augmentation materials for open-wedge high tibial osteotomy[J].Biomaterials,2008,29(26):3497-3502.DOI:10.101 6/j.biomaterials.2008.05.027.
[18] Tetsworth K,Paley D.Malalignment and degenerative arthro-pathy[J].Orthop Clin North Am,1994,25(3):367-377.
[19] Fujisawa Y,Masuhara K,Shiomi S.The effect of high tibial osteotomy on osteoarthritis of the knee:an arthroscopic study of 54 knee joints[J].Orthop Clin North Am,1979,10(3):585-608.
[20] Iorio R,Healy WL.Unicompartmental arthritis of the knee[J].J Bone Joint Surg Am,2003,85(7):1351-1364.
[21] 时剑辉,吕伟,王岩,等.3D打印截骨切模辅助胫骨高位截骨术治疗伴有骨关节炎的膝内翻畸形[J].中国卫生标准管理,2018,9(2):56-57.DOI:10.3969/j.issn.1674-9316.2018.02.0 29.Shi JH,Lyu W,Wang Y,et al.The high tibial osteotomy aided by three-dimensional (3D) printing cutting block for correction of genu varum with osteoarthritis[J].Chin Health Stand Manage,2018,9(2):56-57.DOI:10.3969/j.issn.1674-9316.2018.02.029.
[22] Müller M,Strecker W.Arthroscopy prior to osteotomy around the knee[J].Arch Orthop Trauma Surg,2008,128(11):1217-1221.DOI:10.1007/s00402-007-0398-4.
[23] Adili A,Bhandari M,Giffin R,et al.Valgus high tibial osteotomy.Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee[J].Knee Surg Sports Traumatol Arthrosc,2002,10(3):169-176.DOI:10.1007/s00167 -001-0250-2.
[24] 刘娜,王丙刚.胫骨结节上与结节下截骨治疗膝单间室骨关节炎对比[J].实用骨科杂志,2015,21(11):983-987.DOI:10.13795/j.cnki.sgkz.2015.11.007.Liu N,Wang BG.Treatment of early unicompartmental knee osteoarthritis with varus by high tibial osteotomy:comparison between results of high tibial osteotomy above and below tibial tubercle[J].J Pract Orthop,2015,21(11):983-987.DOI:10.13795/j.cnki.sgkz.2015.11.007.
[25] Lee DC,Byun SJ.High tibial osteotomy[J].Knee Surg Relat Res,2012,24(2):61-69.DOI:10.5792/ksrr.2012.24.2.61.
[26] Sen C,Kocaoglu M,Eralp L.The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up)[J].Knee Surg Sports Traumatol Arthrosc,2003,11(3):139-144.DOI:10.1007/s00167-003-0344-0.
[27] Dugdale TW,Noyes F,Styer D.Preoperative planning for high tibial osteotomy:the effect of lateral tibiofemoral separation and tibiofemoral length[J].Clin Orthop Relat Res,1992,274(274):248-264.DOI:10.1097/00003086-199201000-00025.
[28] Asada S,Akagi M,Mori S,et al.Increase in posterior tibial slope would result in correction loss in frontal plane after medial open-wedge high tibial osteotomy[J].Knee Surg Sports Traumatol Arthrosc,2012,20(3):571-578.DOI:10.1007/s00167-011-1610-1.
[29] Schr?ter S,Gonser CE,Konstantinidis L,et al.High complication rate after biplanar open-wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute[J].Arthroscopy,2011,27(5):644-652.DOI:10.1016/j.arthro.2011.01.008.
[30] 刘培来,卢群山.植骨在胫骨高位截骨术中的应用[J].中华关节外科杂志(电子版),2016,10(5):530-534.DOI:10.3877/cma.j.issn.1674-134X.2016.05.011.Liu PL,Lu QS.Application of bone grafting in high tibial oste-otomy[J].Chin J Joint Surg (Electron Ed),2016,10(5):530-534.DOI:10.3877/cma.j.issn.1674-134X.2016.05.0 11.
[31] Zorzi AR,da Silva HG,Muszkat C,et al.Opening-wedge high tibial osteotomy with and without bone graft[J].Artif Organs,2011,35(3):301-307.DOI:10.1111/j.1525-1594.2010.01 058.x.
[32] Luites JW,Brinkman JM,Wymenga AB,et al.Fixation stability of open- versus close-wedge high tibial osteotomy:a randomised clinical trial using radiostereometry[M].J Bone Joint Surg Br,2009,91(11):1459-1465.DOI:10.1302/0301-620X.91B11.22614.