摘要目的 分析自体骨软骨移植联合开放楔形胫骨高位截骨术(open wedge high tibia osteotomy,OWHTO)治疗膝关节自发性骨坏死(spontaneous osteonecrosis of the knee,SONK)的临床疗效。方法 回顾性分析2017年8月至2019年3月天津市人民医院行自体骨软骨移植联合OWHTO治疗的6例SONK患者,其中男2例,女4例;年龄40~65岁,平均(51.5±7.3)岁;身体质量指数23.5~29 kg/m2,平均(26.7±4.1)kg/m2。依据Aglietti影像分期评估骨坏死,Ⅲ期4例,Ⅳ期2例。坏死灶宽度占所累及股骨髁比例为22%~36%,平均(26.2±5.2)%。入院均完善膝关节正侧位X线、CT和MRI检查明确诊断,测量坏死灶面积。评估手术前后胫骨近端内侧角(medial proximal tibial angle,MPTA)、膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)、美国特种外科医院(the hospital special surgery,HSS)膝关节评分。研究数据采用配对样本 t 检验,P<0.05为差异具有统计学意义。结果 6例患者均获得12个月随访。术后12个月时,患者可主动无痛屈曲至(125.5±7.5)°;HSS评分由术前(64.8±4.2)分提高至(90.5±3.84)分(P<0.05);VAS由术前(7.0±0.3)分降至术后(2.0±0.67)分(P<0.05);MPTA由术前(84.2±0.9)°改善至术后(90.0±1.3)°(P<0.05)。术后膝关节最大主动屈曲活动度范围116°~132°,平均(125.5±7.5)°,与术前活动度相比差异无统计学意义。患者对手术效果非常满意83.3%,满意16.7%。术后均未出现下肢深静脉血栓、肺栓塞、感染、切口愈合不良等并发症,无死亡病例出现。结论 自体骨软骨移植联合OWHTO治疗SONK,术后患者膝关节疼痛明显改善,随访期间未见明显并发症,临床疗效可靠。
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