高石軍，邵德成，陸 搏，王 飛，陳競清，李 彤，陳百成
(河北省石家莊市河北醫科大學第三醫院關節外科，050051)
【摘要】： 目的 探討關節鏡下清理及應用記憶合金騎縫釘固定的脛骨高位截骨術治療膝關節骨關節炎的手術方法、手術適應證及療效。方法 自1999年3月～2003年5月應用記憶合金騎縫釘固定的脛骨高位截骨術結合關節鏡下清理術治療膝關節骨關節炎34例（42膝），男6例（8膝），女28例（34膝），年齡42～67歲（平均54.2歲）。隨訪1a4個月～3a 8個月（平均2a11個月）。關節鏡下發現：髕內側滑膜皺襞10例；內側半月板損傷12例；外側半月板損傷6例；關節軟骨損傷20例；關節內游離體7例；髁間窩狹窄9例，關節鏡下清理后進行脛骨高位截骨，不顯露腓總神經，閉合楔形截骨，行改良脛骨結節前置，保持內側骨膜的穩定性，應用記憶合金騎縫釘固定。結果 膝關節疼痛基本消失，關節功能基本不受影響，膝內翻畸形得到矯正。膝關節評分術前為（53.71土6.7），術后為（91.02±7.7），兩者比較有顯著性差異（p<0.01），優良率為95.24%。術后并發癥少，能早期進行功能鍛煉，無需再次取出內固定。 結論 關節鏡下清理及應用記憶合金騎縫釘固定的脛骨高位截骨術治療膝關節骨關節炎，治療關節內病變，具有操作簡便，固定牢固，神經、血管損傷發生率低，可早期負重，早期進行功能鍛煉，促進骨質愈合，組織相容性好，無須二次手術取出等優點。
【關鍵詞】：骨關節炎； 膝； 內固定器； 脛骨； 骨切開術
Arthroscopic treatment and high tibial osteotomy with fixation of staple made of retention alligation for the treatment of osteoarthritis of the knee// GAO Shi-jun SHAO De-cheng LU Bo, et at Department of joint Surgery the Third Hospital of Hebei Medical University Shijiazhuang 050051
【Abstract】objective To eva luate the results of treatment with arthroscope and high tibial osteotomy with fixation of staple made of retention alligation for osteoarthritis of the knee, and to discuss the indication for this technique.Method From March 1999 to May 2003, 42 arthroscopic treatment and high tibial osteotomies were performed in 34 patients. There were 6 men ( 8 knees) and 28 women ( 34 knees),with a mean age of 54.2 years ( ranged 42~67 years). The average postoperative follow-up was 36 months ( ranged 16~44 months) .The indications for high tibial osteteotomy were unicompartmental osteoarthritis and varus malalignment. After arthroscopic treatment, a lateral closing-wedge osteotomy was perfomed with fixation of staple made of retention alligation. The arthroscopic examination showed plica synovialis in 10 knees , medial meniscus injuries in 12 knees, lateral meniscus injuries in 6 knees,articular cartilage injuries in 20 knees , body loose in joint in 7 knees, intercondylar fossa stenosis in 9 knees. Common peroneal nerve was not exposed and the periosteum opposite to the insicion position was left intact for sake of stability and acted as a hinge around which the wedge osteotomy was closed. The patients were reexamined to obtain a knee score,to make lateral andante roposterior radiograph of the involwd knee with the patient standing. Result During the follow-up the patients showed satifying pain relief improvement of joint function,collection of yams defomity. The average preoperative knee score was 53.714 ±6. 7, The average postoperative knee score at the time of the latest follow-up was 91.02±7.7. Comparing preoperative with postoperative, there were significant differences (P< 0.01). The excellent and good result was 95.24%. Earlier rehabilitation exercise should be carried out and the complication was rare .It is unnecessary to accept another operation to take out of the intemal fixation. Conclusion The advantages of the arthroscopic treatment and high tibial osteotomy with fixation of staple made of retention allegation used to the treatment of osteoarthritis of the knee am significant pathological changes in the knee, convenient application, stable fixation, rare complication, earlier weight loading and rehabilitation, promotion of bone union,good histocompatibility and no need of another operation to take out of the intemal fixation.
【Key words】 Osteoarthritis, knee; Internal fixators Osteotomy, Tibia
