摘要膝关节周围截骨术是纠正膝力线不佳、治疗骨关节炎的重要方法,主要包括股骨远端截骨和胫骨近端截骨。一般情况下膝外翻畸形多是由股骨远端的外翻畸形导致,可以选择股骨远端截骨术。目前临床上最常见的膝内翻畸形多需胫骨近端截骨术矫形。胫骨高位截骨术(high tibial osteotomy,HTO)是目前截骨保膝治疗内翻型骨关节炎常用的手术方式,其中开放式胫骨高位截骨术(Open wedge high tibial osteotomy,OWHTO)是一种有效的治疗膝内翻并单间室关节炎的治疗方法。已有多个研究报道了OWHTO术后获得良好的临床结果,然而并不是OWHTO对所有的膝内翻并单间室关节炎都有良好的效果,对于关节外畸形引起的膝内翻及关节炎均有较好的疗效,但对于关节内畸形或疾患引起的膝内翻并关节炎效果并不理想。OWHTO是一种很好的调整下肢力线的截骨方式,但对于膝关节内畸形导致的内翻,尤其是伴跷跷板效应的患者,可伴有由于组织内外侧不平衡引起的半脱位和推力,单纯调整力线并不能改变关节内骨性匹配及关节周围软组织平衡的问题。为了克服关节内匹配不良等问题,Chiba等于1989年报道了胫骨髁外翻截骨术(tibial condylar valgus osteotomy,TCVO),用于治疗伴有外侧关节半脱位的晚期内侧间室的骨关节炎(osteoarthritis,OA)。该手术的主要策略是矫正力线的同时获得关节的稳定性和更好的匹配性,这是完全不同于OWHTO的一种截骨手术及治疗理念。
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