Valgus Open Wedge High Tiblal Osteotomy without Fibular Osteotomy

肆拾貳位膝關節炎病患；18位男性，24位女性，年齡由30歲至70歲不等，平均55歲。其中42側為骨性關節炎，8例外傷性關節炎。全部接受了無合併腓骨截斷之脛骨上端外翻截骨手術，同時使用三角形狀異體，自體或兩者合併的骨略移置來填補截骨處因矯正外翻鋸開的骨頭。不論有或無內固定，術後均打上石膏保護二側至三星期。病人住院的天數由8至26日不等，平均為11.8天。依照Insall’s的術前及術後評估，病人由62點進步至88.8點，同時原有10度的內翻，經矯正為5度外翻。追踪結果有86.8%的病人情況良好，並無骨略不癒合發生，無血管及神經受傷，亦無術後感染發炎。唯一個病患因手術中，在矯正內翻時，外翻用力過猛，導致腓骨頸骨折。大意地處理而無將截骨處固定，以致再度內翻形式。另一患者則有骨釘鬆動的情形。本手術方法是非常簡易，對治療因膝內翻導致膝中腔關節炎病變是很有效的。尤其本手術無需合併腓骨截骨，不但減經病患術後的疼痛，亦可避免不必要的併發症。

關鍵字

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並列摘要

Forty-two patients who had 42 osteoarthritic and eight traumatic arthritic knees underwent open wedge high tibial osteotomies. The osteotomy sites were filled up with either autogenous, allogeneous or a combination of spaced bone grafts that were secured with or Without internal fixations. An additional post-operative cast protection was employed for two to three weeks. The hospitalization of patients ranged from 8-26 days with an average of 1.8 days. Using Insall’s criteria6,7,the knee score of our patients improved from 62 points pre-operatively to 88.8 points post-operatively. The preoperative mechanical axis alignment averaged 10 degrees varus deformity, while the final follow-up evaluation demonstrated an average of five degrees valgus. There is no non-union, and neither neurovascular injuries nor post-operative infections occurred. However, one of the patients experienced an intraoperative fracturing of the proximal fibular, thus ending up with recurrent varus deformity, and one has a screw loosening. In each case, the three month post-operative X-ray demonstrated good bony union. The overall good and excellent clinical result is 86.8%. It is not a demanding and complicated procedure. It shows exciting and encouraging promise in treating medial compartmental problems of the knee. It is a less painful procedure since no fibulectomy or fibular osteotomy is needed.

並列關鍵字

Valgus high tibial osteotmy ； Triangular bone graft

國際替代計量

Valgus Open Wedge High Tiblal Osteotomy without Fibular Osteotomy

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