According To The Center Of Rotation Of Angulation Minimally Invasive Osteotomy Below The Tibial Tuberosity Treatment Of Unicompartmental Osteoarthritis Of The Knee

Object: Knee osteoarthritis is one of the diseases that affect human health extensively,It is the most common orthopaedic disease in midlife women.X-ray examination shows that the width of internal joint clearance narrowing,limb alignment shifting inward.The surgical methods treatment of knee osteoarthritis mainly include the early bone orthopedics and late knee arthroplasty.The purpose of orthopaedic surgery is: correcting knee coronary tibial articular axis,improving joint mechanical to be balance,reducing knee medial compartment pressure.reducing joint inflammation,relieving pain symptoms,delaying the time of HKA.Previous high tibia osteotomy often as the preferred solution,but there often does not pay attention to preoperative plan and difficult to accurately control in the operation of corrective angle,low patella,internal fixation failure,operation damage blood vessels,nerves or bone cutting line into the joint.This study based on CORA(the center of rotation of angulation)principle,formulated on the basis of the condition of the patients with personalized treatments of osteotomy,cases of unicompartmental osteoarthritis of the knee were treated with minimally invasive osteotomy below the tibial tuberosity,cutting fibula middle and Fixed external fixator.This study evaluated the postoperative clinical effect,summarize data of these cases,and discussing the related issues in clinical application.Methods:Standard of cases selected were as following:1.Age 50 to 70 years old;2.In line with the knee joint osteoarthritis diagnostic criteria,Only the unicompartmental osteoarthritis of the knee,merge varus defor-mity,knee joint lateral extrusion without pain;3.Knee varus deformity is derived from the tibia;4.Have the ability to use crutches after surgery;5.Tibia blood circulation is normal.There were 9 selected patients in our study from February 2015 to October 2015 in Hebei Medicial University Third Hospital and Seventh People's Hospital of Hebei Province,including 2 male and 7 female with mean aged 58 years(ranged from 53-64 years old),mean disease time 6.8 years(ranged from 4-13 years).Based on the principles of CORA make the preoperative planning:1.Form measuring and analysis the double lower limbs length of X ray film,make sure the knee varus deformity comming from the tibia;2.Determine CORA position;3.Determine the way of osteotomy;4.Determine the parts of bone cutting;5.Determine the correct degree;6.Choose proper fixation methods.All the cases received the treatment that minimally invasive osteotomy below the tibial tuberosity,cutting fibula middle and Fixed external fixator.All patients were followed up 1 month,2 months,3 months,five months,seven months,9 months,12 months.X-ray were examined when the patients were ordered to stand on feet.observe limb alignment.Measure the MPTA;observe bone cutting area healing,note down New York rating system of Surgical Special Hospital and keen society score.All the statistics are dealed by the related procedure in SPSS 10.1(SPSS Inc,Chicago,IL).The difference of the measurement data was compared with the paired t test.P<0.05 denotes the difference possessing statistical significance.Results :All patients were followed up for 5-12 months(mean,8.4 months).8 cases with a healing time of 5 months,1 case with a healing time of 7 months,1 case with lateral sural cutaneous nerve paralysis.After operation,X ray film show that limb alignment were very good.MPTA was recovered form preoperative 80.6~0±2.0~0 to postoperative 93.4~0±2.1~0,the correct degrees was 12.5~0±1.7~0,there had significanted difference between preoperative and postoperative(t=21.850,P=0.000).HSS score was recovered form preoperative 53.2±5.5 to postoperative 82.1±6.7,there had significanted difference between preoperative and postoperative(t=11.058,P=0.000).KSS score was recovered form preoperative 62.6±1.7 to postoperative 80.4±2.1,there had significanted difference between preoperative and postoperative(t=21.850,P=0.000).Conlution:1 Minimally invasive osteotomy below the tibial tuberosity,cutting fibula middle and Fixed external fixator for the treatment of Unicompartmental osteoarthritis of the knee can get the correct limb alignment and deformity correction were found.HSS score and KSS score had significant improvement postoperatively,there had statistical significance difference between preoperative and postoperative.2 Based on the principles of CORA make the scientifically preoperative planning,measure limb alignment,Analyze the source of anomaly,determine CORA position,determine the correct degree.According to the preoperative plan strictly,adhere to the principle of minimal invasive,firmly fixed osteotomy site,the operation will be successful.3 Fibula middle cutting during operation help to improve joint mechanical to be balance,reducing knee internal compartment pressure.The action of fibula cutting and tibia osteotomy was accumulative.The clinical effect of it strengthened obviously...