Application of laser reticle equipment in medial open-wedge high tibial osteotomy
-
摘要:目的
观察激光标线仪在提高内侧开放楔形胫骨近端高位截骨术（MOWHTO）中的应用效果。
方法将60例膝关节骨性关节炎患者纳入本研究，其中30例术中按照传统定位法测量下肢力线（对照组），另外30例术中使用激光标线仪实时显示下肢力线（观察组）。比较2组手术时间、术中C臂使用次数、引流量、OA距离，并比较术前、术后3个月和6个月的视觉模拟评分法（VAS）评分、美国特种外科医院（HSS）膝关节功能评分及屈膝最大角度。比较2组并发症和不良反应。
结果与对照组比较，观察组手术时间、引流量、C臂使用次数及OA距离均较短或较少，差异有统计学意义（P < 0.05）。与对照组比较，观察组术后3个月的VAS评分较低，膝关节HSS评分较高，差异有统计学意义（P < 0.05）。2组患者术后6个月的屈膝最大角度与术后3个月比较，差异有统计学意义（P < 0.05）；与对照组比较，观察组术后3个月的屈膝最大角度较大，差异有统计学意义（P < 0.05）。对照组发生1例下肢深静脉血栓，给予对症处理后未出现严重不良反应。观察组患者未发生并发症或不良反应。
结论MOWHTO术中使用激光标线仪标记下肢力线可有效缩短手术时间和OA距离，减少引流量、C臂使用次数，改善术后VAS评分、膝关节HSS评分及屈膝最大角度。
Abstract:ObjectiveTo observe the application effect of laser reticle equipment in medial open-wedge high tibial osteotomy(MOWHTO).
MethodsA total of 60 patients with knee osteoarthritis were included in the study, among whom 30 patients underwent traditional positioning method to measure the lower extremity alignment (control group) and 30 cases used a laser reticle equipment to display the lower extremity alignment in real time (observation group). The operation time, intraoperative C-arm usage times, drainage volume and OA distance were compared between two groups. The visual analogue scale (VAS), the knee function score of Hospital for Special Surgery(HSS) and the maximum angle of knee flexion were compared between two groups before operation and 3 and 6 months after the operation. The complications and adverse reactions of two groups were compared.
ResultsCompared with the control group, the operation time, volume of drainage, C-arm usage times and OA distance in the observation group were significantly reduced or shortened (P < 0.05). Compared with the control group, the VAS score of the observation group was lower and the knee HSS score was higher 3 months after surgery, the differences were statistically significant (P < 0.05). The maximum angle of knee bending 6 months after surgery showed significant difference compared with that 3 months after surgery (P < 0.05). Compared with the control group, the observation group had a larger maximum bending angle 3 months after surgery, and the difference was statistically significant (P < 0.05). The control group had one case of deep venous thrombosis of lower extremity, and no serious adverse reactions occurred after symptomatic treatment. No complications or adverse reactions occurred in the observation group.
ConclusionThe laser reticle equipment used to mark the lower limb alignment in MOWHTO operation can shorten the operation time and OA distance, reduce drainage volume and C-arm usage times, and improve postoperative VAS score, knee HSS score and maximum knee flexion angle.
-
-
表 1 2组患者一般情况比较(x±s)[n(%)]
一般资料 对照组(n=30) 观察组(n=30) 男 14(46.67) 17(56.67) 女 16(53.33) 13(43.33) 年龄/岁 49.82±7.23 50.44±6.82 体质量指数/(kg/m2) 21.35±4.23 22.64±5.06 左膝 16(53.33) 18(60.00) 右膝 14(46.67) 12(40.00) Kellgren-Lawrence分级 Ⅱ级 18(60.00) 19(63.33) Ⅲ级 12(40.00) 11(36.67) 病程/年 2.65±0.95 2.95±0.87 
下载: 导出CSV
表 2 2组手术时间、引流量、C臂使用次数及OA距离比较(x±s)
组别 n 手术时间/min 引流量/mL C臂使用次数/次 OA距离/mm 对照组 30 59.32±11.02 81.03±25.11 9.01±1.51 11.71±2.71 观察组 30 50.21±9.03* 66.03±29.24* 6.02±1.62* 7.92±2.32* 与对照组比较, *P < 0.05。
下载: 导出CSV
表 3 2组患者VAS评分比较(x±s)
分 组别 n 术前 术后3个月 术后6个月 对照组 30 6.84±1.42 1.54±0.43* 0.85±0.28*# 观察组 30 6.94±1.63 1.13±0.46*△ 0.72±0.27*# 与术前比较, *P < 0.05; 与术后3个月比较, #P < 0.05;
与对照组比较, △P < 0.05。
下载: 导出CSV
表 4 2组患者膝关节HSS评分比较(x±s)
分 组别 n 术前 术后3个月 术后6个月 对照组 30 62.58±5.36 72.34±6.25* 86.29±7.02*# 观察组 30 63.99±5.98 80.15±6.78*△ 89.15±7.16*# 与术前比较, *P < 0.05; 与术后3个月比较, #P < 0.05;
与对照组比较, △P < 0.05。
下载: 导出CSV
表 5 2组患者屈膝最大角度比较(x±s)
° 组别 n 术前 术后3个月 术后6个月 对照组 30 93.56±5.36 100.36±6.24* 116.35±7.11*# 观察组 30 94.18±5.56 108.41±6.39*△ 118.46±7.39*# 与术前比较, *P < 0.05; 与术后3个月比较, #P < 0.05;
与对照组比较, △P < 0.05。
下载: 导出CSV
-
[1] 黄野. 胫骨高位截骨术治疗膝关节骨关节炎的现状[J]. 中华关节外科杂志: 电子版, 2016, 10(5): 470-473. doi: 10.3877/cma.j.issn.1674-134X.2016.05.001 [2] CHALMERS B P, LIMBERG A K, TIBBO M E, et al. Total knee arthroplasty after high tibial osteotomy results in excellent long-term survivorship and clinical outcomes[J]. J Bone Joint Surg Am, 2019, 101(11): 970-978. doi: 10.2106/JBJS.18.01060
[3] RODRIGUEZ-MERCHAN E C. Unicompartmental knee osteoarthritis (UKOA): unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO)[J]. Arch Bone Jt Surg, 2016, 4(4): 307-313.
[4] HAVIV B, BRONAK S, THEIN R, et al. Mid-term outcome of opening-wedge high tibial osteotomy for Varus arthritic knees[J]. Orthopedics, 2012, 35(2): e192-e196.
[5] 袁荣霞, 胡勇, 李强, 等. 关节镜下清理结合胫骨高位截骨术治疗膝内侧骨关节炎[J]. 四川医学, 2009, 30(3): 342-343. doi: 10.3969/j.issn.1004-0501.2009.03.020 [6] 胡晓晖, 赏后来, 郝跃东. 胫骨高位双平面截骨术治疗膝内侧间室骨性关节炎的临床研究[J]. 中国骨与关节损伤杂志, 2019, 34(2): 170-172. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201902021.htm [7] KUMAGAI K, AKAMATSU Y, KOBAYASHI H, et al. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 779-784. doi: 10.1007/s00167-016-4096-z
[8] MINIACI A, BALLMER F T, BALLMER P M, et al. Proximal tibial osteotomy. A new fixation device[J]. Clin Orthop Relat Res, 1989(246): 250-259.
[9] PAPE D, SEIL R, ADAM F, et al. Imaging and preoperative planning of osteotomy of tibial head osteotomy[J]. Orthopade, 2004, 33(2): 122-134. doi: 10.1007/s00132-003-0585-0
[10] 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. doi: 10.1016/S0030-5898(20)30753-7
[11] MARTAY J L, PALMER A J, BANGERTER N K, et al. A preliminary modeling investigation into the safe correction zone for high tibial osteotomy[J]. Knee, 2018, 25(2): 286-295. doi: 10.1016/j.knee.2017.12.006
[12] 张建国, 聂文忠, 王成焘, 等. 全膝关节置换手术导引中股骨头中心定位精度的实验研究[J]. 生物医学工程学杂志, 2008, 25(6): 1435-1437. doi: 10.3321/j.issn:1001-5515.2008.06.042 [13] 石繁槐, 张婧, 刘允才. 基于手眼式机器人的股骨中心定位方法: CN1686056A[P]. 2005-10-26. [14] 任江涛, 徐丛, 王建松, 等. 三维打印个性化导板与传统截骨工具在全膝关节置换术中疗效比较的Meta分析[J]. 中华外科杂志, 2017, 55(10): 775-781. doi: 10.3760/cma.j.issn.0529-5815.2017.10.012 [15] 胡军, 姚庆强, 刘帅, 等. 3D打印辅助全膝关节置换术的临床应用[J]. 中华关节外科杂志: 电子版, 2017, 11(2): 122-127. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHGJ201702003.htm [16] VAN DEN BEMPT M, VAN GENECHTEN W, CLAES T, et al. How accurately does high tibial osteotomy correct the mechanical axis of an arthritic Varus knee A systematic review[J]. Knee, 2016, 23(6): 925-935. doi: 10.1016/j.knee.2016.10.001
[17] LEOPOLD S S. Editor's spotlight/take 5: 2017 chitranjan S. ranawat award: does computer navigation in knee arthroplasty improve functional outcomes in young patients A randomized study[J]. Clin Orthop Relat Res, 2018, 476(1): 3-5. doi: 10.1007/s11999.0000000000000081
[18] 徐维臻, 翟文亮, 苏瑞龙, 等. 自制股骨头中心点定位装置在胫骨高位截骨术中的应用[J]. 中国骨与关节损伤杂志, 2020, 35(8): 838-839. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202008019.htm
计量
- 文章访问数:
- HTML全文浏览量:
- PDF下载量:
苏公网安备 32100302010246号