【摘要】 ［目的］探讨GIEBEL内固定系统固定的胫骨高位截骨术治疗膝内翻畸形的效果。［方法］对19例31膝，平均53.5岁的膝内翻患者进行评价。术前内翻畸形平均12.29°；膝关节症状以内侧间室疼痛为主。不伴有其他关节间室病变。对患膝进行精确的胫骨高位截骨术后应用GIEBEL系统内固定截骨端。手术前后拍摄双下肢负重位全长X线片，测量内翻角、机械轴线和解剖轴线。记录内外侧关节间隙距离的差值以及关节活动度。同时进行Lysholm评分。术后对患者进行主观满意度调查。［结果］对19例患者平均随访22个月。术后1例腓总神经一过性麻痹，2例切口脂肪液化延迟愈合。截骨处至术后12～16周均骨性愈合。测量矫正角度平均12.32°。3例患者残留膝前疼痛和关节绞锁症状。在随访期间膝内外侧间隙无明显退变加重。手术效果优良率为89.5%。84.2%患者对手术效果表示满意。除膝关节活动度外，Lysholm评分、内外关节间隙差以及内翻角度在手术前后差异均有统计学显著性差异。［结论］GIEBEL系统可有效地固定胫骨高位截骨术截骨端，对轻中度膝关节内翻畸形患者固定强度大，骨愈合率高。
【关键词】 胫骨； 截骨术； 畸形； 内固定
Clinical application of the GIEBEL system in high tibial osteotomy∥
Abstract：［Objective］To discuss the results of the GIEBEL system in high tibial osteotomy to treat varus knee.［Method］Nineteen patients with medium varus knee were selected to be treated with osteotomy.Preoperatively,the mean varus angle was 12.29°,without deformity in other department of the knee joint.The main symptom was the pain in medial department.Accurate high tibial osteotomy with GIEBEL system fixation was performed in 31 knees of these patients.Weightbearing extremity Xray testing,varus angle,mechanical axle and anatomical axle were marked preoperatively and postoperatively.Joint space discrepancy between lateral and medial joint,the range of motion,Lysholm assessment and objective satisfactory survey were also performed to determine the outcome of the treatment.［Result］The mean followup of nineteen patients was 22 months.During this period,one case of temporary common fibular nerve paralysis occurred and healed at several days.All of the osteomy interface achieved bony healing.The corrected abnormality was 12.32°.The mechanism axle of the extremity maintained as the level just after operation during the followup and no degeneration of the joint space aggravated.The excellent and good rate of the treatment was 89.5%,and 84.2% of the patients expressed satisfactory for the operation.No difference of the range of motion was found before and after operation,but the Lysholm score,joint space discrepancy between lateral and medial joint and varus angle were improved after the osteotomy.［Conclusion］The GIEBEL system can fixate the bony interface of the high tibial osteotomy effectively,and possess the advantages of minimal invasion,stronger intensity and higher healing rate.
Key words：tibial; osteotomy; deformity; internal fixation
膝关节内翻畸形产生症状的原因是由于下肢负重力线转移到膝内侧间室，局部高应力负荷所致。胫骨高位截骨术可从冠状面上纠正力线异常，对于此类疾病有较确切的治疗效果。坚强的内固定对于优良的疗效是必要因素，可保证截骨愈合和早期功能康复。GIEBEL系统是专为胫骨近端截骨术设计的新型内植物，其张力带固定模式和较大的骨接触面积使得骨愈合率增高。本文对2000年2月～2006年2月本科施行的GIEBEL系统固定的胫骨高位截骨术进行结果分析，探讨GIEBEL系统在胫骨截骨术中的价值。
1 资料与方法
1.1 一般资料
本组共19例31膝，男8例，女11例；年龄38～65岁，平均53.5岁。术前内翻畸形6°～20°，平均12.29°；膝关节活动度大于90°；术前膝关节症状以内侧间室疼痛为主。不伴有其他关节间室病变；膝关节稳定性无明显异常。
1.2 手术方法
术前纠正患者的全身伴发疾病如心脑血管疾病、糖尿病等。选用硬膜外麻醉9例，全身麻醉10例。患者取仰卧位于可透X线手术床上。膝外侧切口起自关节间隙上方约2 cm，在膝关节外侧中部弧形向下止于腓骨头远端，胫骨结节外下方，显露并截除与拟截骨楔形底面等长的腓骨。沿髂胫束后侧和胫骨嵴切开，剥离显露胫骨外髁。保持屈膝90°，以便腘窝血管、神经以及腓总神经移向后侧，并可使髂胫束松弛。在膝关节内外侧间隙插入腰穿针作为标记。在胫骨平台关节面下方1 cm处平行关节面打入2 mm克氏针，C型臂X线机透视确定位置良好。在克氏针下方避开上胫腓关节，由前外向后内打入槽形刀，应避免腓骨小头妨碍钢板L形柄部贴近胫骨而引起软组织愈合问题。安装截骨导向器，将第2根克氏针平行第1根克氏针打入导向器孔内，按术前计划测量楔形骨块底边长度在其下方斜行打入第3根克氏针。去除槽形刀和截骨导向器，沿槽形刀路径打入GIEBEL钢板紧贴胫骨外侧皮质。骨膜下放置牵开器保护腘窝血管神经。沿第2、3根克氏针方向截除楔形骨块，对侧薄层骨皮质用细克氏针钻孔折断，以保证对侧骨膜和软组织袖的完整。轻轻折断对侧骨皮质使截骨面合拢，将两根皮质骨螺钉斜行拧入远端骨块内，穿出对侧皮质固定。放置引流管1根，逐层关闭切口。转贴于 酷文网-论文下载中心 http://www.coolwen.net
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