GIEBEL系统在胫骨高位截骨术中的应用Clinical application of the GIEBEL system in high tibial osteotomy
张海宁;王英振;吕成昱;刘金钊;王湘达;王昌耀;
摘要(Abstract)：
[目的]探讨GIEBEL内固定系统固定的胫骨高位截骨术治疗膝内翻畸形的效果。[方法]对19例31膝,平均53.5岁的膝内翻患者进行评价。术前内翻畸形平均12.29°;膝关节症状以内侧间室疼痛为主。不伴有其他关节间室病变。对患膝进行精确的胫骨高位截骨术后应用GIEBEL系统内固定截骨端。手术前后拍摄双下肢负重位全长X线片,测量内翻角、机械轴线和解剖轴线。记录内外侧关节间隙距离的差值以及关节活动度。同时进行Lysholm评分。术后对患者进行主观满意度调查。[结果]对19例患者平均随访22个月。术后1例腓总神经一过性麻痹,2例切口脂肪液化延迟愈合。截骨处至术后12~16周均骨性愈合。测量矫正角度平均12.32°。3例患者残留膝前疼痛和关节绞锁症状。在随访期间膝内外侧间隙无明显退变加重。手术效果优良率为89.5%。84.2%患者对手术效果表示满意。除膝关节活动度外,Lysholm评分、内外关节间隙差以及内翻角度在手术前后差异均有统计学显著性差异。[结论]GIEBEL系统可有效地固定胫骨高位截骨术截骨端,对轻中度膝关节内翻畸形患者固定强度大,骨愈合率高。
关键词(KeyWords)： 胫骨;截骨术;畸形;内固定
基金项目(Foundation):
作者(Author): 张海宁;王英振;吕成昱;刘金钊;王湘达;王昌耀;
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参考文献(References)：
- [1]Preston CF,Fulkerson EW,Meislin R,et al.Osteotomy about theknee:applications,techniques,and results[J].J Knee Surg,2005,18(4):258-272.
- [2]Christodoulou NA,Tsaknis RN,Sdrenias CV,et al.Improvement ofproximal tibial osteotomy results by lateral retinacular ralease[J].ClinOrthop Relat Res,2005,441:340-345.
- [3]Marti RK,Verhagen IRA,Kerkhoffs GM,et al.Proximal tibial yams os-teotomy.Indications,technique,and five to twenty-one-year results[J].J Bone Joint Surg,2001,83:164-170.
- [4]Amendola A,Panarella L.High tibial osteotomy for the treatment ofunicompartmental arthritis of the knee[J].Onhop Clin North Am,2005,36(4):497-504.
- [5]王飞,陈竞清,陈百成,等.胫骨高位截骨术治疗膝内翻伴膝外步态的疗效与不足[J].中国矫形外科杂志,2006,14(5):343-345.
- [6]Wright JM,Crockett HC,Slawski DP,et al.High tibial osteotomy[J].Am Acad Orthop Surg,2005,13(4):279-289.
- [7]蒋垚,沈灏,顾新丰,等.Koshino胫骨高位截骨结合外固定支架治疗膝内侧髌股型骨关节炎[J].中国矫形外科杂志,2005,13(23):1765-1767.
- [8]Dowd GS,Somayaji HS,Uthukuri M.High tibial osteotomy for medialcompartment osteoarthritis[J].Knee,2006,13(2):87-92.
- [9]Spahn G,Kirschbanm S,Kahl E.Factors that influence high tibial os-teotomy results in patients with medial gonarthritis:a score to predictthe results[J].Osteoarthritis Cartilage,2006,14(2):190-195.
- [10]Tang WC,Henderson U.High tibial osteotomy:long term survival anal-ysis and patients perspective[J].Knee,2005,12(6):410-413.
- [11]Billings A,Scott DF,Camargo MP,et al.High tibial osteotomy with acalibrated osteotomy guide,rigid internal fixateon,and early motion.Long-term follow-up[J].J Bone Joint Surg,2000,82:70-79.