References

rsp

Научно-практическая ревматология

Rheumatology Science and Practice

1995-44841995-4492

IMA-PRESS, LLC

10.47360/1995-4484-2021-215-224

rsp-3025

Research Article

РЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯ

ORTHOPEDIC RHEUMATOLOGY AND REHABILITATION

Осложнения открывающей угол высокой тибиальной остеотомии. Анализ причин и пути их устранения

Complications of open wedge high tibial osteotomy. Analysis of the causes of complications and ways to eliminate them

https://orcid.org/0000-0002-3745-0924

Бялик

В. Е.

Bialik

V. E.

Бялик Валерий Евгеньевич

115522, Москва, Каширское шоссе, 34а

Valerii E. Bialik

115522, Moscow, Kashirskoye Highway, 34A

DoctorBjalik@yandex.ru

https://orcid.org/0000-0001-8563-0631

Макаров

С. А.

Makarov

S. A.

115522, Москва, Каширское шоссе, 34а

Sergey A. Makarov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7938-1536

Бялик

Е. И.

Bialik

E. I.

115522, Москва, Каширское шоссе, 34а

Evgeniy I. Bialik

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7179-8174

Нестеренко

В. А.

Nesterenko

V. A.

115522, Москва, Каширское шоссе, 34а

Vadim A. Nesterenko

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6847-6396

Нурмухаметов

М. Р.

Nurmukhametov

M. R.

115522, Москва, Каширское шоссе, 34а

Maksim R. Nurmukhametov

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation

2021

12052021

592215224

2021

Бялик В.Е., Макаров С.А., Бялик Е.И., Нестеренко В.А., Нурмухаметов М.Р.

Bialik V.E., Makarov S.A., Bialik E.I., Nesterenko V.A., Nurmukhametov M.R.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://rsp.mediar-press.net/rsp/article/view/3025

Цель исследования – изучить осложнения открывающей угол высокой тибиальной остеотомии (ОУВТО) у пациентов, перенесших данную операцию в ФГБНУ НИИР им. В. А. Насоновой.Материалы и методы. В исследование были включены 43 пациента с первичным и вторичным остеоартритом (ОА) коленного сустава (КС) I–III стадии, которым была выполнена ОУВТО в период с 2005 по 2019 г. Операцию выполняли по стандартной методике с применением коротких пластин с фиксированным спейсером (в 5 случаях – Puddu I поколения, в 24 – Puddu II поколения, в 17 – Osteomed) и костной пластикой. Выявленные характерные для ОУВТО осложнения разделили на связанные с этапом остеотомии, с фиксацией и с костной пластикой. Для оценки результата изучали изменение интенсивности боли по визуальноаналоговой шкале (ВАШ), а также состояние КС по шкале Knee Society Score (KSS) до операции, по прошествии 3 месяцев и 1 года после ОУВТО.Результаты. В 15 (32,7%) случаях были диагностированы 26 осложнений. Из них 21 (81,0%) осложнение связано с фиксацией, 2 (7,7%) – с этапом остеотомии, 2 (7,7%) – с костной пластикой остеотомического клина, 1 (3,6%) осложнение – местное. Через 3 месяца после операции у пациентов без осложнений статистически значимо больше снижалась интенсивность боли по ВАШ (р=0,0005) и улучшался общий счет KSS (р=0,0023). Через 1 год после ОУВТО отличные и хорошие результаты были получены у 96,7% пациентов без осложнений и у 60% пациентов, перенесших осложнения. Всего через 1 год после операции были выявлены 43,5% отличных, 41,3% хороших и 15,2% удовлетворительных результатов.Выводы. ОУВТО – высокоэффективный метод хирургического лечения ОА КС, позволяющий в 84,8% случаев получить отличный и хороший результаты лечения через 1 год после операции. Выполнение ОУВТО с фиксацией высоты остеотомического клина при помощи коротких пластин с фиксированным спейсером и костной пластикой в 32,7% случаев сопряжено с развитием осложнений. Для улучшения результатов ОУВТО необходимо совершенствовать хирургическую технику операции и фиксатор.

Objective – to study the complications of open wedge high tibial osteotomy (OWHTO) in patients who underwent this surgery in the V.A. Nasonova Research Institute of Rheumatology.Materials and methods. The study included 43 patients (46 knee joints) with primary and secondary OA of the knee of I–III stages, who underwent OWHTO in the period from 2005 to 2019. The operation was performed according to the standard technique using short spacer plates (Puddu I (5 times) and II generation (24 times), Osteomed (17 times)) and bone grafting. The identified OWHTO specific complications were divided into those related to the osteotomy, fixation, and bone grafting. To assess the result, we studied the change in pain according to the Visual Analog Scale (VAS), as well as the functional and objective state of the knee according to the Knee Society Score (KSS) before surgery, after 3 months and 1 year after surgery.Results. In 15 (32.7%) cases have been diagnosed 26 complications. Of these, 21 (81.0%) were associated with fixation, 2 (7.7%) with the osteotomy 2 (7.7%) with bone grafting of the osteotomy gap, and 1 (3.6%) a local complication. Patients without complications had a statistically significantly better decrease in pain intensity according to VAS (p=0.0005), and an improvement in the total score of KSS (p=0.0023) one year after surgery. Outcomes were also better in patients without complications: 96.7% excellent and good results versus 60.0% in patients with complications one year after OWHTO. In total, we had 43.5% excellent, 41.3% good and 15.2% satisfactory results one year after surgery.Conclusions. OWHTO is a highly effective method of surgical treatment of the osteoarthritis of the knee, which allows to obtain an excellent and good treatment result in 84.8% of cases one year after surgery. Performing OWHTO with fixing the height of the osteotomy gap using short spacer plates and bone grafting in 32.7% of cases is associated with the development of complications. To improve the results of OWHTO, it is necessary to improve the surgical technique and fixator.

открывающая угол высокая тибиальная остеотомияостеоартритколенный суставосложненияфиксаторкостная пластикаостеотомический клин

open wedge high tibial osteotomyosteoarthritisknee jointcomplicationsfixatorbone graftingosteotomy gap

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The authors declare that there are no conflicts of interest present.