胫骨高位截骨术后腿长差异的临床疗效观察

Clinical Efficacy of Leg Length Difference on High Tibial Osteotomy

摘要: 目的：通过对照研究内侧开放胫骨高位截骨术(open wedge high tibial osteotomy, OWHTO)和外侧闭合胫骨高位截骨术(close wedge high tibial osteotomy, CWHTO)后腿长差异(leg length discrepancy, LLD)对治疗膝关节骨关节炎临床疗效的影响。方法：回顾性分析自2019年9月至2020年9月于我院行HTO手术治疗的膝关节内侧间室骨关节炎患者，共纳入60例，60膝，按照患者的手术方式将其分为OWHTO组和CWHTO组。观察两组患者的腿长差异、下肢力线纠正情况、膝关节功能和相关并发症的差异。结果：术前OWHTO组和CWHTO组的基线资料差异无统计学意义，术前及术后18个月OWHTO组和CWHTO组的下肢力线差异无统计学意义，膝关节功能及疼痛评分差异无统计学意义。LLD，OWHTO术后患肢延长(6.1 ± 1.5) mm，CWHTO患肢延长(1.2 ± 1.3) mm，两组差异有统计学意义，LLD大的患者对侧膝关节疼痛和腰背部疼痛的发生率较高。结论：OWHTO和CWHTO均能有效纠正下肢力线、缓解膝关节疼痛和提高膝关节功能，OWHTO术后明显增加LLD并且LLD大者出现对侧膝关节疼痛和腰背疼痛的概率增加。术者进行HTO时应充分考虑LLD，术前应进行详细的截骨规划避免过大的LLD。

Abstract: Objective: A controlled study was conducted to investigate the effect of medial open high tibial os-teotomy and lateral closed high tibial osteotomy on leg length disparity (LLD). Methods: A total of 60 patients with medial compartment osteoarthritis of the knee who underwent HTO surgery in our hospital from September 2019 to September 2020 were included in the retrospective analysis. Six-ty knees were divided into the OWHTO group and the CWHTO group according to the surgical method of the patients. The differences in leg length, clinical efficacy, knee joint function and relat-ed complications of the two groups were observed. Results: There were no significant differences in baseline data, lower extremity force lines, knee joint function, or pain scores before and 18 months after surgery between the OWHTO and CWHTO groups. The limb lengths of the LLD, OWHTO and CWHTO patients after surgery were (6.1 ± 1.5) mm and (1.2 ± 1.3) mm, respectively. The differences between the two groups were statistically significant. The patients with the largest LLD had higher probability of contralateral knee joint pain and lower back pain. Conclusion: Both OWHTO and CWHTO can effectively correct the lower limb tension line, relieve knee joint pain and improve knee joint function. The LLD after OWHTO surgery is significantly increased, and the probability of con-tralateral knee joint pain and low back pain in patients with large LLD is increased. The LLD should be fully considered by the operator when performing HTO, and detailed osteotomy planning should be performed preoperatively to avoid excessive LLD.