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1、有 二 nn膝关节骨关节炎X片分级Classification) :0级: 正常;1级: 关节间隙可疑变罕，可能有骨效1级: 有了明显的骨赣，关节让 茎度变窄;111级: 中等量骨效，关节间隙变窒较明确，软骨下骨骨质轻度硬化改变，范围较小; IIV级: 大量骨赣形成，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。 正当关全 祖居节克破坏的中着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? 保膝治疗可和否? 肥骨高位截骨术?四膝关节骨关节炎手术治疗方案 ES素二的仙怀尺晒区蕊-冰一怠肥式一 -拒全织SI=归三红吧人S全册咎“己由上本捷既 吏居 -师 从瑟了和莽电
2、后醒烟丝回 。 旱季 志 .护扣机贞杞忌 笑 .皇 柜才阔获冰时冰巧”咽居攻”喝下疼准媒笑尔返”共并中强骨|民明狼 1 ，国有 ss 和概述 肥骨高位截骨术 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: 通过有径骨近端截骨，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。TD Ostenlomy fr Orteoartiritis of the KneeBy TINEG
3、SORNIFTCI WO WECRITmrauenuaina at the kaec Jamicuias bei下niade io ak straight eatthe jine ofasociated with a latenil (valeus or varus) Kneeoint remaine obtque to the horizontaldeformig。 When there disabling pain bat a。 plane。 ln spite of this theoretical objection theood range_ of mhovement correcti
4、on of thi opemation improves the stability of the joint andeermity by oatcotomy sa logical procedure。 reliever the stnain on the medial ligarmentThe jointis realigpned so that the forces of weight。 9 Paticnts (10 kness) with painfal osteoarthritibearing are more cvenly distributed and no longer 。 ha
5、ve had an upper tibial osteotomy: 6 for valgusoncentraled in the medial or tenil compart。 and 4 for vanus deformity，The average age want 的yearsand the avenage folowrup forty monthena walgus knee the deformity largsiy occurs All were substantially relieved of Pain各the lowerend of he femur yoa supraco
6、ndyiar except One (who had both Knees operaiosteotomny woaid scemn indicalcd， Jn 4 patients Fecovered more than 30作 Rnecs) his has been carried out bat 旭 cach There were no vascular complications。 A ballase there was serioug restriction of movement and socket type of ostcotomy through the adfthe bon
7、e Ifithis osteotomy isdone for valgus bilimtion is only needed for eight to tenorOsteotomy of the Upper Portion of the Tibiafor Degenerative Arthritis of the KneeA Paausu Rumomrren se Slowf Ohoprdic Srgry Mamn Clinicand Mam Foumatan ioninier Wpts to treat degenerative arthritis of the knee by surgic
8、al means haveed_ latellectomny or Patelioplasty may be done in the preence of symptorxiading removal of joseecasionally umed Arihrodesis athritis of bear more oftheir weightThe mnale knee noraally tends toward a the tibial eondyle that bears the most weight the natuaral varus orereasest ds yiciousei
9、releisset pin which iacr asing defonnityreasing degenerative clank Te Uninvoived cyndye Ratd joint spueeeaually appear nonaat 革f Ne eold be ieresjel omed art 说 woald wetn thathe knee joint eomwiderably pr 和24例共30有 中患者，其中12例共18|满意的临床疗效，以明显 ; Insall等曾说: 从长期随访来看，如果以转行全膝关节置换术total kneearthroplasty，TKA)
10、作为HT0失败的终末点的话，截骨术的失败率并不高，一般在20%以下，见下表。表1 不同文献报道 HTO 治疗的患者最终转而行 TKA 手术的发生率生存举(TKA 翻修 随访时间作者 例数/总例数) 年)1 0 SARa 0 clnoniop 19as 8 0 Ac Onlop bag 1994WaiFS |soy中中腹po mh qhrows Da昌 有司 1ime Dan 9 chir ioosoa 093 0 Rev Chi olop 1993al .4056 00-i50 clnoniop 992uabaig 0028 L0 An onhop seand_1990注:HTO影骨高位截此术
11、;TKA-全杯关节慎换术0denbring等采用HT0治疗314例，随访时间为10-19年，其中144例力线矫正满意，170例力线矫正不足。前者只有8例接受了翻修，后者有54例接受了翻修。0denbring认为，如果准确地实行HT0，其生存时间可与TKA的生存时间相媲美。国有 ”HTO适应症lndications)由患者小于65岁女性100”) ;仅限于内侧间室骨性关节炎;屈曲挛缩畸形15” ，有翼骨内翻畸形5”;内侧肥骨近端角 (medial proximal tibial angle，MPTA) 85” ;外侧软骨和半月板功能正常;韧带存在，无关节不稳。Patient Selectiof|
12、 :jdevelepsd 内 TSMKOs| (Intefnatiofal society ofArthroscopy)moderately active high-demand (but not jumping or running)young (between 40-60 years old) with isolated medial joint 1ine tendernessBMI30，malalignment15*15mm) heavy smokers和本到加HTO与单铅置换术 (UKA) 适应症区分通过矫正力线从而减压膝关节内侧负荷 人英囊外手术 ii 关节抽考术J吕而CEmutftoUW GoOn豚骨内翻越大，关节内磨损越小越好 关节内磨损越大，关节外内翻越小越好 韧带要求不高 韧带功能要好” -中 Was 4 wmHTO的成功需包含以下三大要素 1. 适当的患者选择 right patient selection) 2. 安全准确的手术技术 safe and accurate operation ) 3. 可靠的内冉定stablel internal fixatiorm)
