1、HTO新進展北京積水潭醫院矯形骨科JPEG，AOTK黃野CWHTO for OABegin to do HTO in early 80s fixed with castCWHTO proximal to TT, fixed with Giebel plate CWHTO through distal third TT, fixed with L-shaped LCP plate J Orthop Surg Res. 2014; 9: 9.Long-term follow-up14 years post-op19 years post-opLong term survivorship: Only

2、 520 HTOs converted to TKA（By Surgery of the Knee）作者生存率（翻修例數總例數）隨訪時間(年)文獻（年份）Holden3/5110JBJS Am (1988)Rudan14/12815Clin Orthop (1991)Bouharras4/1188Acta Orthop Belg (1994)Hernigou15/9320Rev Chir Orthop (1996)Ivarsson8/6511.9JBJS Br (1990)Levigne17/2179Chir de genou (1991)Lootvoet14/1938Rev Chir Ort

3、hop (1993)Yasuda4/561015Clin Orthop (1992)Odenbring0/2811Acta Orthop Scand (1990)Long term survivorship: 15年以上隨訪有85以上的生存率Koshino: 97.3% 7yr, 95.1% 10yr, 86.9% 15yr, (2004)Flecher: 85% 20yr (2006)Akizuki: 97.6% 10yr, 90.4% 15yr (2008)Saito: 98.5%, 510（6.5）yr (2014)Ritter MA, Fechtman RA: proximal tib

4、ial osteotomy: A survivorship analysis. J Arthroplasty.57年隨訪，很多HTO病例組的結果都令人滿意，但是其后滿意率顯著下降。HTO可靠治療時間約為6年Berman AT:Factors influencing long-term results in high tibial osteotomy. Clin Orthop.39 HTO, 64% 12yr4 廣泛OA，2類風濕，1既往感染，1創傷后關節炎合并嚴重畸形生存率 79 12yr 排除適合患者后適應癥的把握對臨床結果至關重要（HTO是針對性很強的手術）。Chillag KJ: Hig

5、h tibial osteotomy: A retrospective analysis of 30 cases. Orhopedics. 198430 HTO，43 51mo1330（滿意）：力線矯正滿意1730(不滿意)：5 矯正不足，3過度矯正，2 進關節，11并發癥糟糕的手術技術有損臨床結果 Hernigou P: Proximal tibial osteotomy for osteoarthritis with vaus deformity . A 10 to 13 year follow-up study. JBJA Am, 198793 HTO, 90% 5yr, 45% 10y

6、r.其中力線矯正滿意的20例患者，術后11.5yr隨訪，無一例失敗矯正不足可以獲得短期的高的滿意度，但長期隨訪滿意度差隨著時間的推移，臨床結果受影響的似乎僅限于那些矯正不足或過度矯正的病例。Odenbring S: Revision after osteotomy for gonarthrosis: A 10-19 year follow-up of 314 cases.1990314 HTO, 62/314（翻修）, 10-19yr170例矯正不足：54例翻修（68.2）144例矯正充分：8例翻修（94.5）精確控制力線的HTO，臨床結果可與TKA生存時間相媲美。印度，2003，7.5yr隨

7、訪滿意率僅60% 2006年,8.4yr 隨訪滿意率僅61.1%Puddu鋼板固定的開放截骨的總并發癥發生率高達43不合理的內固定選擇造成HTO術后角度的丟失，并發癥的增加，和糟糕的遠期臨床結果。Key factors for success of HTOPatient selectionsAccurate techniquesReliable fixation plete osteotomy with Tomofix fixation 精確的控制力線穩定的內固定和快速康復很小的損傷和很少的并發癥Little invasive，less complications切口位于脛骨近端前內側顯露容易

8、，組織損傷小不截腓骨，并發癥少Accurate alignment controlFujisawa PointAccurate alignment adjustmentReliable fixation, early rehab截骨專用鎖定鋼板固定牢靠允許患者早期下地活動保留對側合頁雙平面截骨愈合迅速3 mo post-op: fast rehabOne year post-op: good bone healing without correction loss結構性人工骨植骨AO annual reportAORecon strived further in reaching its ta

9、rget to improve patient care in joint preservation and replacement.AOTK JPEG明年推出New K wire guideFree angle adjustment in 3D Handle of K-wire guide away from fluoroscopyaim at the cross pointKeep holes round under x-ray indicate the instrument is horizontal slide in the K-wire GuideAssure K-wires are

10、 parallel to the frontal planeSlide the saw guide over the k-wireThe direction of the holes keep the two K-wires parallelUnder fluoroscopy, let the second k-wire overlap the first, then drill in till to the lateral cortex. Insert the Second K-wire Assure K-wires are parallel to the frontal planeWhat is OWHTO+Tomofix for China?是一個技術標準（Standardized techniques） 手術的程序化結果的可重復性是一個教育平臺（Continuous educati