胫骨高位截骨新外固定架的研制与应用△

Development and application of a new-style external fixator for high tibial osteotomy

摘要:

[目的]介绍胫骨高位截骨新外固定架的研制与应用的手术技术和初步临床结果。[方法]该装置以螺纹杆和可锁定关节铰链做主架，搭配钢针固定件和 8 根装置固定钉使用，安装后可通过调节外固定架上的螺母优化术后矫形效果。选择合适患者行胫骨高位截骨术，安装可调式外固定器，术后根据复查 X 线片行截骨角度调整，直至达到目标力线，在骨折愈合后可拆除外固定架。[结果]12 例患者均顺利完成手术，随访 6~12 个月，下肢膝关节功能恢复时间平均（3.2±0.2）个月。影像方面， 所有患者均骨性愈合。胫骨近端内侧角（medial proximal tibial angle, MPTA）由术前的（79.2±3.4）° 增加至术后（87.1±2.5）°（P＜ 0.001），关节线相交角（joint line convergence angle, JLCA）由术前的 2°~4° 矫正至术后的＜2°（P＜0.001）。[结论] 胫骨高位截骨新外固定架治疗膝关节骨关节炎可有效改善膝关节功能和生活质量，但仍需进一步做相关对照研究验证。

Abstract:

[Objective] To introduce the development, application and preliminary clinical results of a new-type external fixator for high tibial osteotomy. [Methods] The device was composed of threaded rod and lockable hinge as the main frame, attached with 8 pin for bone fixation. After installation, the postoperative correction could be optimized by adjusting the nuts on the external fixer. As appropriate patients were selected for high tibial osteotomy with the adjustable external fixator, the osteotomy angle was adjusted according to reexamination X-ray films after surgery until the target alignment was reached. The external fixator could be removed after osteotomy site healed. [Results] All the 12 patients were successfully operated on and followed up for 6~12 months, with an average recovery time of knee function of (3.2±0.2) months. Radiographically, all patients showed the osteotomy site healed, with medial proximal tibial angle (MPTA) significantly increased from (79.2±3.4)° preoperatively to (87.1±2.5)° postoperatively (P＜0.001), while the joint line convergence angle (JLCA) corrected from 2°~4° preoperatively to ＜2° postoperatively (P＜0.001). [Conclusion] The high tibial osteotomy with this new-type external fixator for knee osteoarthritis does effectively improve knee function and quality of life, however, it still needs to be further verified by relevant control studies.