بررسي نتايج راديوگرافيك استئوتومي باز پروگزيمال تيبيا

Radiographic Results of High Tibial Open Wedge Osteotomy

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﺳﺘﺌﻮﺗﻮﻣﻲ ﻋﻤﻞ ﮐﻼﺳﻴﮏ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺍﺳﺘﺌﻮﺍﺭﺗﺮﻳﺖ ﺩﮊﻧﺮﺍﺗﻴﻮ ﺍﻭﻟﻴﻪ ﻭ ﺍﺻﻼﺡ ﺩﻓﻮﺭﻣﻴﺘﻲ ﺁﻥ ﺍﺳﺖ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻨﮑﻪ ﺩﺭﻣﺎﻥ ﻫﺎﻱ ﻣﺨﺘﻠﻔـﻲ ﺑﺮﺍﻱ ﺍﺻﻼﺡ ﮊﻧﻮﻭﺍﺭﻭﻡ ﻭﺟﻮﺩ ﺩﺍﺭﺩ، ﺍﺭﺯﻳﺎﺑﻲ ﻫﺎﻱ ﺩﻗﻴﻖ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻭ ﻣﻘﺎﻳﺴﻪ ﺁﻥ ﺑﺎ ﺍﻧﺪﺍﺯﻩ ﻫﺎﻱ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻧﻘﺶ ﻣﻬـﻤﻲ ﺩﺭ ﺗﻌﻴﻴﻦ ﻣـﻮﻓﻘﻴﺖ ﻋﻤﻞ ﻭ ﭘﻴﮕﻴـﺮﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺍﺭﺩ. ﻫﺪﻑ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮﺭﺳﻲ ﺗﻐﻴﻴﺮﺍﺕ ﺭﺍﺩﻳﻮﻟﻮﮊﻳﻚ ﺩﺭ ﺍﻳﻦ ﺩﺳﺘﻪ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻳﮏ ﻣﻄﺎﻟﻌﻪ Case Series ﺩﺭ ﺑﺎﺯﻩ ﺯﻣﺎﻧﻲ 1383 ﺗﺎ 1389 ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻣﺒﺘﻼﻳﺎﻥ ﺑﻪ ﺍﺳﺘﺌﻮﺁﺭﺗﺮﻳﺖ ﻋﻼﻣﺖ ﺩﺍﺭ ﮐﻤﭙﺎﺭﺗﻤﺎﻥ ﺩﺍﺧﻠﻲ ﺯﺍﻧﻮ ﺑﺎ ﺯﻣﻴﻨﻪ ﺑﺪﺷﮑﻠﻲ ﻭﺍﺭﻭﺱ ﺯﺍﻧﻮ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺍﺳﺘﺌﻮﺗﻮﻣﻲ ﺗﻴﺒﻴﺎ ﺑﺎ ﮔﻮﻩ ﺑﺎﺯ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ، ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﺭﺥ ﺍﻳﺴﺘﺎﺩﻩ ﺍﺯ ﮐﻞ ﺍﻧﺪﺍﻡ ﻭ ﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﻟﺘﺮﺍﻝ ﺷﺎﺧﺺ ﻫﺎﻱ ﺍﻣﺘﺪﺍﺩ ﺍﻧﺪﺍﻡ ﻗﺒﻞ ﻭ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﻣﺠﻤﻮﻉ 29 ﺑﻴﻤﺎﺭ، 36 ﺯﺍﻧﻮ ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ، ﺍﺯ ﺍﻳﻦ ﺗﻌﺪﺍﺩ 14 ﻧﻔﺮ ﺍﺯ ﺁﻧﻬﺎ ﺯﻥ ﻭ 15 ﻧﻔﺮ ﻣﺮﺩ ﺑﻮﺩﻧﺪ. ﺳﻦ ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﮐﻤﺘﺮ ﺍﺯ 50 ﺳﺎﻝ ﺑﻮﺩ )10/88±27/64 ﺩﺭ ﺁﻧﺎﻟﻴﺰ ﭼﻨﺪ ﻣﺘﻐﺒﺮﻩ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﻣﺘﻐﻴﻴﺮ ﺷﻴﺐ ﺧﻠﻔﻲ ﺗﻴﺒﻴﺎ ﻭ ﻣﻴﺰﺍﻥ ﺁﺭﺗﺮﻭﺯ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺘﻪ ﺑﻮﺩ. ﺍﻳﻨﺪﮐﺲ Insall-Salvatiﻭ ﺍﻳﻨﺪﮐﺲ Blackburn-Peel ﺩﺭ ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺗﻐﻴﻴﺮﻱ ﭘﻴﺪﺍ ﻧﮑﺮﺩﻩ ﺑﻮﺩ. ﺩﻭ ﻣﻮﺭﺩ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﻋﻠﺖ ﺩﻓﻮﺭﻣﻴﺘﻲ ﻫﻤﺰﻣﺎﻥ ﺩﺭ ﺩﻳﺴﺘﺎﻝ ﻓﻤﻮﺭ ﺍﺻﻼﺡ ﮐﺎﻣﻞ ﭘﻴﺪﺍ ﻧﮑﺮﺩﻧﺪ. 3 ﻣﻮﺭﺩ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﻋﻠﺖ ﺍﺷﻜﺎﻝ ﺩﺭ ﺗﻜﻨﻴﻚ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﺎﻋﺚ ﺷﻜﺴﺘﮕﻲ ﺩﺭ ﭘﻼﺗﻮ ﻟﺘﺮﺍﻝ ﺣﻴﻦ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺷﺪﻧﺪ ﻛﻪ ﻋﻠﺖ ﻋﺪﻡ ﺟﺎﺑﺠﺎﻳﻲ ﺯﻳﺎﺩ ﺑﺎ ﺩﺭﻣﺎﻥ ﻏﻴﺮ ﺟﺮﺍﺣﻲ ﺩﺭ ﻃﻮﻝ ﭘﻴﮕﻴﺮﻱ ﻫﺎ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ ﭘﻴﺪﺍ ﻧﻤﻮﺩﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﺌﻮﺗﻮﻣﻲ ﺑﻪ ﺭﻭﺵ ﺑﺎﺯ ﻣﻲ ﺗﻮﺍﻧﺪ ﻧﺘﺎﻳﺞ ﺭﺿﺎﻳﺖ ﺑﺨﺸﻲ ﺩﺭ ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺭﺍﺩﻳﻮﻟﻮﮊﻳﻚ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺍﺳﺘﺌﻮﺍﺭﺗﺮﻳﺖ ﺩﮊﻧﺮﺍﺗﻴﻮ ﺍﻭﻟﻴﻪ ﻭ ﺍﺻﻼﺡ ﺩﻓﻮﺭﻣﻴﺘﻲ ﺁﻧﻬﺎ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ. ﺟﻬﺖ ﺩﺳﺘﻴﺎﺑﻲ ﺑﻪ ﻧﺘﺎﻳﺞ ﺧﻮﺏ ﺍﻧﺘﺨﺎﺏ ﺻﺤﻴﺢ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺍﺭﺯﻳﺎﺑﻲ ﺩﻗﻴﻖ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻧﻴﺎﺯ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Osteotomy is the classic operation for the treatment of patients with primary degenerative osteoarthritis and for the correction of their deformity. Considering the existence of different methods for their treatment, preoperational assessment and its comparison with post operation measures has a significant role in determining the prosperity of surgery and patient's follow up. The aim of this study is to investigate the radiologic changes in these patients. Materials & Methods: In a case series study from 2004 to 2010 in Shafa Yahyaeeian hospital (a referral hospital in Tehran, Iran) patients with osteoarthritis who had signs and symptoms of medial compartment of knee and varus deformity underwent open wedge tibial osteotomy. Using anteroposterior and lateral radiography in standing position, the limbs alignment before and after the operation were investigated. Results: Totally 29 patients (36 knees) were investigated. Fourteen patients were females. All of them were younger than 50 years with mean ± SD (27.64 ± 10.88). The follow up time was (4.33 ± 1.7). Tibial slope and grade DJD increased after operation. Insall-salvati and Blackburn-peel indices had no change. Two cases were not corrected completely, due to simultaneous deformity in the distal of femur. Three cases had fracture of lateral plateau due to some technical problems during operation. They had little dislocation and were treated completely in next follow up by using nonsurgical treatment. Conclusions: Open wedge osteotomy can have good results in the radiologic finding and deformity correction of patients with primary degenerative osteoarthritis