前交叉韧带重建联合胫骨高位截骨治疗前交叉韧带损伤合并骨关节炎的临床疗效

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摘要目的探究前交叉韧带重建联合胫骨高位截骨术治疗前交叉韧带损伤合并内侧间室骨关节炎患者的临床疗效。方法回顾性分析2015年6月至2018年2月唐山市第二医院收治的前交叉韧带损伤合并内侧间室骨关节炎伴内翻畸形的18例患者资料，男10例，女8例；年龄42～57岁，平均(51.20±4.80)岁，均同期行关节镜探查清理前交叉韧带重建和胫骨高位截骨术，术后1、6、12、24个月行门诊随访，复查双下肢全长及患膝正侧位X线片，了解截骨线愈合情况，测量下肢机械轴通过点，胫骨后倾角；末次随访时行Lachman试验、KT-1000试验客观评价膝关节前后稳定性，采用Lysholm评分、Tegner膝关节运动评分和国际膝关节文献委员会(international knee documentation committee，IKDC)评分评价膝关节功能。结果患者均获随访，随访时间24～36个月，平均(28.30±5.70)个月，期间无关节僵直、感染、骨不愈合或延迟愈合，2例术后患肢胫后静脉血栓形成，给予积极抗血栓治疗。末次随访时，患者Lysholm评分、Tegner膝关节运动评分、IKDC评分较术前均明显改善，差异均有统计学意义(P＜0.05)；末次随访测量下肢机械轴由术前内翻(7.05±2.34)°调整到术后外翻(1.22±0.43)°，差异有统计学意义(P＜0.05)；胫骨平台后倾角术前(9.16±1.41)°，术后(10.24±2.37)°，差异无统计学意义(P＞0.05)；4例患者在连续X线片上显示出进行性内侧间室骨关节炎明显加重表现，末次随访患肢查体Lachman试验阳性3例。结论前交叉韧带重建联合胫骨高位截骨术可有效改善关节稳定性及骨关节炎症状，临床效果满意，但较高的关节炎进展率及韧带松弛率不容被忽视。

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	刘国立
	李亮
	易凡
	谢坤南
	尹向辉
	张艳蕊
	戴士峰

关键词 ：胫骨高位截骨, 前交叉韧带, 骨关节炎, 膝关节内翻

Abstract：Objective To investigate the clinical effect of anterior cruciate ligament reconstruction combined with high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with medial compartment osteoarthritis.Methods A retrospective analysis was performed on 18 patients with anterior cruciate ligament injury complicated by medial single-compartment osteoarthritis at the Second Hospital of Tangshan from June 2015 to February 2018.There were 10 males and 8 females with an average age of (51.20±4.80)years (range，42~57 years).Cruciate ligament reconstruction and tibial high osteotomy were performed simultaneously.Follow-up visits were made at 1，6，12 and 24 months after operation.Full-length radiographs of lower limbs and anteroposterial-lateral radiographs of affected knee were reviewed，the union of osteotomy line was investigated，and the passing point of mechanical axis of lower limb and posterior tibial angle were measured.At the last follow-up，Lachman test and KT-1000 test were performed to objectively evaluate the stability of the knee joint.Lysholm score，Tegner knee motion score and international knee documentation committee (IKDC) score were used to evaluate knee function.Results All patients were followed up for 24~36 months，with an average of (28.30±5.70)months.There was no joint stiffness，infection，bone nonunion or delayed union during the follow-up period.2 patients developed postoperative tibial vein thrombosis and received active antithrombotic therapy.At the last follow-up，Lysholm score，Tegner knee motion score and IKDC score were significantly improved compared with those before surgery(P<0.05).At last follow-up，the mechanical axis of lower extremity was adjusted from preoperative varus (7.05±2.34)° to postoperative valgus (1.22±0.43)°，and the difference was statistically significant (P<0.05).The posterior angle of tibial plateau was (9.16±1.41)° before operation and (10.24±2.37)° after operation，and the difference was not statistically significant (P>0.05).Continuous radiographs in 4 patients showed progressive medial compartment osteoarthritis exacerbation，Lachman test was positive in 3 cases.Conclusion Anterior cruciate ligament reconstruction combined with high tibial osteotomy can effectively improve joint stability and osteoarthritis symptoms，and the clinical effect is satisfactory，but the high rate of arthritis progression and ligament relaxation should not be ignored.

基金资助:河北省医学科学研究课题(20221731)

作者简介: 刘国立(1987－ )，男，主治医师，唐山市第二医院关节与运动医学科，tslglfly@163.com

引用本文:

刘国立，李亮，易凡，谢坤南，尹向辉，张艳蕊，戴士峰. 前交叉韧带重建联合胫骨高位截骨治疗前交叉韧带损伤合并骨关节炎的临床疗效[J]. 实用骨科杂志, 2022, 28(8): 691-695.
Liu Guoli，Li Liang，Yi Fan，Xie Kunnan，Yin Xianghui，Zhang Yanrui，Dai Shifeng. Clinical Effect of Anterior Cruciate Ligament Reconstruction Combined with High Tibial Osteotomy in the Treatment of Anterior Cruciate Ligament Injury Combined with Osteoarthritis. sygkzz, 2022, 28(8): 691-695.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I8/691

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