Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee
Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee
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DOI：
10.1007/s00167-008-0698-4
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发表时间：
2009-04-01
影响因子：
3.8
通讯作者：
Saito, Tomoyuki
中科院分区：
文献类型：
--
作者：
Takeuchi, Ryohei;Aratake, Masato;Saito, Tomoyuki
在早期负重方面，我们评估了使用开放楔形胫骨高位截骨术（OWHTO）使用TomoFix （TM）和人工骨替代物治疗膝关节内侧股骨髁自发性骨坏死（SONK）的临床结果。对30例平均年龄为71岁（58-82岁）的患者的30个膝关节进行OWHTO手术，切除受损软骨组织，钻孔坏死区域。截骨术后1周允许患者进行部分负重运动，所有患者在术后2周进行完全负重运动。平均随访时间为40个月（24-62个月）。所有的SONK患者在接受OWHTO治疗2周后，仅使用t型拐杖即可完全负重行走。临床分析，包括平均美国膝关节学会评分和功能评分，分别显示从51分到93分和58分到93分的显著改善。术前，站立时的平均股胫角（FTA）为181度（解剖内翻1A度），随访时明显改变为170度（外翻10A度）。所有患者均无骨不连或种植体失败的病例。此外，30例患者中有21例（70%）在治疗后能以日本式坐姿坐下，而术前均无一例患者能以日本式坐姿坐下。30例假体移除手术中有24例可观察到关节镜检查结果。坏死区均被纤维软骨样组织完全覆盖。在坏死区域钻孔，然后使用TomoFix和人工骨替代物进行OWHTO是治疗SONK的有效方法，因为它可以减轻疼痛并使坏死军团上的纤维软骨组织再生。此外，手术后早期负重锻炼计划是可能的，完全负重可以在手术后两周实现。
We evaluated the clinical outcomes, in terms of early weight bearing, of using opening wedge high tibial osteotomy (OWHTO) to treat spontaneous osteonecrosis of the medial femoral condyle of the knee (SONK) using TomoFix (TM) and artificial bone substitute. Damaged cartilage tissue was removed and drilling of the necrotic area followed by OWHTO was performed in 30 knees from 30 patients with an average age of 71 years (range 58-82) at the time of operation. Patients were allowed to undertake partial weight-bearing exercises 1 week after the osteotomy procedure, with all patients performing full weight-bearing exercise at 2 weeks post-surgery. The mean follow-up period was 40 months (range 24-62). All of the SONK patients could walk with a full weight-bearing load, using only a T-cane, at 2 weeks after undergoing OWHTO. Clinical assays, including the mean American Knee Society Score and Function Score, showed significant improvements from 51 to 93 points, and 58 to 93 points, respectively. Prior to surgery, the average femoro-tibial angle (FTA) during standing was 181 (1A degrees anatomical varus) and had significantly changed to 170 (10A degrees valgus) at the time of follow-up. There were no cases of non-union, or implant failure in any of our patients. In addition, none of the patients could sit in the Japanese style prior to surgery, but 21 of 30 patients (70%) could do so after treatment. Arthroscopic findings could be observed in 24 out of 30 cases at implant removal. Necrotic area in each case was covered with fibrous cartilage-like tissue completely. Drilling of the necrotic area followed by OWHTO with TomoFix and artificial bone substitute is an effective treatment for SONK as it results in pain alleviation and regeneration of the fibrous cartilage tissue over the necrotic legion. In addition, an early weight-bearing exercise program is possible after this procedure and full weight-bearing can be achieved at two weeks after surgery.