Ilizarov技术治疗中老年膝骨关节炎内侧间室疼痛的临床观察

摘要

Objective To investigate the minimally invasive bone cutting under the tibial tubercle,the Ilizarov draft orthopedic technology,for the treatment of the pain due to senile knee medial compartment osteoarthritis.Methods Retrospective analysis was performed in 34 patients treated with Ilizarov technique from April 2012 to October,2013.A total of 48 knees (14 knees) were treated.Among them,11 cases were male,23 cases were female.The age was from 51 to 76,with an average of 65.7 years old.The disease duration was from 2 to 15 years,with an average of 5.1 years.The priority symptom was pain in the medial compartment of the knee.The history of treatment was more than 2 years.The range of knee joint activity was measured (142 ±9.3°) and the knee function was evaluated according to the KSS score.The X-ray of both lower extremities of 34 cases was examined.The degree of power line shift of the lower extremities and the femoral and tibial angle (FTA) were measured.The bone was cut 2-3 cm under the tibia1 tubercle,and the Ilizarov circular external fixation support was installed.After 5 days line draft orthopedic extraction was performed.After 10-15 days,the X-ray of the lower extremmities was examined.When the force lines and FTA were normal,the external fixation support was lock.The patients were requested to do walking exercise.When bone cutting edge completely calcified and reached osseous healing about 12 to 16 weeks after the operation,the external fixation support was removed.Results The average fixation removing time in 34 patients was 13.8 weeks.All patients were followed up for 18-36 months,with an average of 18.7 months.The knee KSS score was recorded,Conclusion Minimally invasive bone cutting under the tibial tubercle and Ilizarov circular external fixation support draft correction for the treatment of senile knee medial compartment osteoarthritis pain are characterized with accurate curative effect and micro orthopedic trauma.%目的 探讨胫骨结节下微创截骨,Ilizarov技术牵伸矫形,治疗中老年膝骨关节炎内侧间室疼痛的效果.方法 回顾分析2012年4月至2013年10月,采用Ilizarov技术牵伸治疗的34例患者,共计48个膝关节(14人双膝治疗).其中,男11例,女23例;年龄51到76岁,平均65.7岁.病程2～15年,平均病程为5.1年,症状均以膝内侧间室疼痛为主的膝骨关节炎患者.均有2年以上中、西医结合治疗病史.测量膝关节活动范围(142.0±9.3).,并根据KSS评分评判患膝功能.34例患者术前均拍双下肢全长X线片,测量双下肢力线移位程度及股胫夹角(FTA).采用胫骨结节下2～3cm处截骨,安装Ilizarov环形外固定支架.术后第5天行牵伸成骨矫形,10～ 15d后,拍双下肢X线片,确定下肢力线及股胫夹角达到正常值后,锁定外固定支架.要求扶拐行走锻炼,待截骨端成骨完全钙化达到骨性愈合,约12 ～ 16w后,拆除外固定支架.结果 34例患者平均13.8w拆外固定支架;所有患者均获18 ～ 36个月随访,平均18.7个月,并行膝关节KSS评分.结论 胫骨结节下微创截骨,Ilizarov环形外固定支架牵伸矫正,治疗中老年膝骨关节炎内侧间室疼痛,具有矫正准确、疗效确切、微创伤、成骨矫形等特点.