保膝治疗之一——胫骨高位截骨术PPT课件

一膝关节骨关节炎X片分级(Classification):0级：正常；一级：关节间隙可疑变窄，可能有骨赘；1级：有明显的骨赘，关节间隙轻度变窄；1I级：中等量骨赘，关节间隙变窄较明确，软骨下骨骨质轻度硬化改变，范围较小；1V级：大量骨赘形成，可波及软骨面，关节间隙明显变窄，硬化改变极为明显，关节肥大及明显畸形。正常膝关节被骨性关节炎破坏的膝关节对于膝关节骨关节炎患者，除了膝关节置换术，能否选择其他？保膝治疗可否？胫骨高位截骨术？膝关节骨关节炎手术治疗方案全膝关节置换术(Tota|Knee Arthrop|asty,TKA):置换整个关节面，矫正力线，假体使用寿命较长，缓解疼痛疗效肯定。适用于整个膝关节软骨磨损严重，并伴有内翻畸形患者。单髁置换术(Uincomparmental Knee Arthroplasty,UKA):只置换内侧部分关节面，可矫正轻度内翻，保留了患者所有的韧带，缓解关节内侧疼痛疗效确切，适用于单纯内侧软骨磨损患者。腓骨截骨术(Fibula0 steotomy,F0):通过腓骨截骨改变胫骨平台的受力情况，从何减轻胫骨平台内侧负荷，缓解疼痛，延缓膝关节骨关节炎进展。但目前尚无询证医学证实以及临床长期随访结果支持。胫骨高位截骨术(High Tibial0 steotomy,HT0):通过胫骨高位截骨，矫正另线，适角于合并严重内翻的膝关节骨关节炎，可延缓关节炎进展，保留了膝关节的正常活动功能一一称之为保膝治疗。随着技术水平的提高，内固定材料的稳定性增强，此术式越来越受骨科医师以及患者青睐，常用于早中期膝关节骨关节炎的治疗。概述-胫骨高位截骨术(High tibia osteotomy,HT0)1958年首先由Jacksn报道；直到1965年Covertry开始倡导并推广，认为HT0可以缓解关节疼痛，并将此术式称之为安全有效的治疗措施。目的：通过胫骨近端截骨，将力线从磨损的内侧间室转移至相对正常的外侧间室，延缓内侧间室的破坏，延长膝关节的使用寿命，推后或避免行膝关节置换术。Tibial Osteotomy for Osteoarthritis of the KneeBy J.P.JACKSON,F.R.C.S.,and W.WAUGH,M.Chir.,F.R.C.S.OsTEOARTHRIrs of the knee is sometimes the leg is made to look straight but the line of theassociated with a lateral (valgus or varus)knee-joint remains oblique to the horizontaldeformity.When there is disabling pain but a plane.In spite of this theoretical objection thegood range of movement correction of thisoperation improves the stability of the joint anddeformity by osteotomy is a logical procedure.relieves the strain on the medial ligament.The joint is realigned so that the forces of weight-9 patients (10 knees)with painful osteoarthritisbearing are more evenly distributed and no longer have had an upper tibial osteotomy:6 for valgusconcentrated in the medial or lateral compart-and 4 for varus deformity.The average age wasment.60 years and the average follow-up forty months.In a valgus knee the deformity largely occurs All were substantially relieved of pain and allin the lower end of the femur so a supracondylarexcept one (who had both knees operated on)osteotomy would seem indicated.In 4 patientsrecovered more than 90 degrees of flexion.(5 knees)this has been carried out but in each There were no vascular complications.A ballcase there was serious restriction of movement and socket type of osteotomy through theafter operation.When,however,the deformity cancellous bone of the upper tibia is recom-is varus,osteotomy through the upper tibia is mended (the fibula being divided in its mid-correct since the angulation occurs in this partshaft).This unites quickly and plaster immo-of the bone.If this osteotomy is done for valgusbilization is only needed for eight to ten weeks.