OrthoPilot导航下内侧开放楔形胫骨高位截骨△

OrthoPilot navigation assisted medial opening wedge high tibial osteotomy for medial knee osteoarthritis

摘要:

［目的］介绍 OrthoPilot 导航下内侧开放楔形胫骨高位截骨（medial opening wedge high tibial osteotomy, MOWHTO）的手术技术和初步临床效果。［方法］2018 年 8 月—2021 年 2 月对 34 例膝内侧室骨性关节炎患者（44 膝）采用上述手术方式治疗。术前采用“截骨大师”进行规划，术中采用 OrthoPilot 导航，按程序完成股骨内、外上髁，胫骨内侧平台中点，屈膝 90°膝关节中心，内、外踝高点、踝关节中心、髋关节中心、膝关节中心的注册，获得膝关节内翻角度及机械轴通过胫骨平台的相对位置。按步骤截骨，撑开器撑开截骨面，至导航显示力线调整至 Fugisawa 点，最后用 Tomofix 钢板固定。［结果］ 34 例患者 4 膝（4/44，9.09%）术中有合页骨折，1 例术后出现伤口感染。平均随访（22.32±7.88）个月，末次随访 HSS 评分显著优于术前 （P<0.05），末次随访患者满意率 94.12% （32/34）。［结论］ OrthoPilot 导航下 MOWHTO 是一种可有效治疗内侧间室膝关节炎的手术方式，可显著改善症状，术后满意度高。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of medial opening wedge high tibial osteoto- my (MOWHTO) under OrthoPilot navigation for medial knee osteoarthritis. [Methods] From August 2018 to February 2021, 34 patients (44 knees) with osteoarthritis in the medial compartment of the knee were treated with the above surgical methods. The surgical plan was made by using the "osteotomy master" preoperatively. Intraoperatively, the OrthoPilot navigation was used to register the medial and lateral femo- ral condyles, the medial tibia platform midpoint, knee center at 90 degrees of flexion, medial and lateral ankle high points, as well as hip, knee and ankle centers to get knee varus angle and mechanical aligment by the relative position of the tibia platform. Osteotomy was per- formed according to the plan, then a spreader was used to hold the osteotomy gap until the navigation displayed the alignment adjusted to Fugisawa point. Finally, a Tomofix plate was used to fix the osteotomy. [Results] Of the 34 patients, 4 knees (4/44, 9.09%) had hinge frac- ture during operation, and 1 case had wound infection after operation. The follow-up lasted for (22.32±7.88) months. The HSS score signifi- cantly improved at last follow-up significantly compared with that before surgery (P＜0.05) , with satisfaction rate of 94.12% (32/34) at lat- est follow-up. [Conclusion] This OrthoPilot navigation assisted MOWHTO is an effective surgical method for medial knee osteoarthritis, which does significantly improve the symptoms with high postoperative satisfaction.