苏州大学附属第一医院骨科;厦门大学附属第一医院骨科;
目的：探讨OrthoPilot导航辅助内侧开放楔形胫骨高位截骨术（OWHTO）治疗内侧间室膝骨关节炎的中期疗效。方法：选取2018年6月至2021年4月苏州大学附属第一医院行OrthoPilot导航辅助下OWHTO病例，并以性别、年龄为条件，匹配同一时间段相同例数的传统器械下OWHTO病例作为对照，最终纳入导航组38例42膝和传统组40例42膝。导航组行OrthoPilot导航辅助OWHTO，传统组行传统器械下OWHTO。记录两组患者围手术期相关指标，包括手术时间、下肢力线位置、目标与实际矫正角度、目标与实际撑开高度，并计算下肢力线位置偏倚值、矫正角度偏倚值和撑开高度偏倚值。观察记录两组患者手术前后影像学评估指标，包括机械胫股角（mTFA）、胫骨近端内侧角（MPTA）、关节线汇聚角（JLCA）。于术前、术后3 d、术后1个月记录膝关节活动度（ROM）；于术前、术后1个月、术后1年及末次随访时记录美国特种外科医院膝关节评分（HSS）和Lysholm评分。观察术后1年内患者并发症发生情况。结果：患者随访42～76个月，平均（60.78±9.54）个月。导航组患者手术时间长于传统组，差异有统计学意义（P<0.05）；导航组患者术后下肢力线位置、术后矫正角度、术后撑开高度均大于传统组，差异均有统计学意义（P均<0.05）。导航组患者力线位置偏倚值>3%的例数、矫正角度偏倚值、撑开高度偏倚值均小于传统组，差异均有统计学意义（P均<0.05）。术后1 d，导航组患者mTFA、MPTA均大于传统组，差异均有统计学意义（P均<0.05）。术后各个时间点，两组患者膝关节ROM均大于术前，Lysholm评分、HSS均高于术前，差异均有统计学意义（P均<0.05）。术后1年，两组患者膝关节ROM均大于术后3 d,Lysholm评分和HSS均高于术后1个月，差异均有统计学意义（P均<0.05）。末次随访时，两组患者Lysholm评分和HSS均高于术后1个月和术后1年，差异均有统计学意义（P均<0.05）。导航组患者术中合页骨折发生率（2膝，4.8%）低于传统组（6膝，14.3%），但差异无统计学意义（P=0.137）。结论：OrthoPilot导航辅助OWHTO治疗内侧间室膝骨关节炎能够取得良好的中期临床疗效。与传统术式相比，OrthoPilot导航辅助OWHTO在实现目标力线精准定位和提高手术稳定度方面更具优势。
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]王熠军,郑恺,张连方等.OrthoPilot导航辅助胫骨高位截骨术治疗内侧间室膝骨关节炎的中期疗效[J].中华骨与关节外科杂志,2025,18(03):222-230.
基金信息:
国家自然科学基金（82072498）; 苏州市临床重点病种诊疗技术专项（LCZX202302）