Billings A, Scott D F, Camargo M P, Hofmann A A
Department of Orthopedics, University of Utah School of Medicine, Salt Lake City 84132, USA.
J Bone Joint Surg Am. 2000 Jan;82(1):70-9. doi: 10.2106/00004623-200001000-00009.
We studied the results of sixty-four valgus-producing high tibial osteotomies performed with the use of a calibrated osteotomy cutting guide and rigid internal fixation, and followed by early motion, in fifty-six patients who had medial unicompartmental osteoarthritis and varus malalignment. Long-term studies have demonstrated that a high tibial osteotomy performed with staple fixation and followed by immobilization in a cast has an expected survival rate of approximately 85 percent at five years and 60 percent at ten years (in studies of ninety-five knees and 213 knees, respectively). To the best of our knowledge, there are no long-term reports on high tibial osteotomies performed with a calibrated osteotomy cutting guide and rigid internal fixation and followed by early motion.
The indications for high tibial osteotomy were medial unicompartmental osteoarthritis and varus malalignment. A lateral closing-wedge osteotomy was performed. The patients were reexamined to obtain a knee score, to make lateral radiographs of both knees, and to make a full-length anteroposterior radiograph (showing the entire lower extremity, including the hip and ankle) of the involved knee with the patient standing.
Twenty-one knees were treated with a subsequent total knee arthroplasty at an average of sixty-five months after the high tibial osteotomy. The remaining forty-three knees had a good or excellent clinical result, with an average knee score of 94 points at an average of 8.5 years after the osteotomy. Survivorship analysis showed an expected rate of survival, with conversion to a total knee arthroplasty as the end point, of 85 percent at five years and 53 percent at ten years. No patient had patella baja postoperatively. There were six complications: four superficial wound infections, one superficial-vein thrombosis, and one delayed union (union occurred at five months).
High tibial osteotomy has been criticized because of a high rate of complications, a loss of effectiveness with time, and the difficulty of conversion to a total knee arthroplasty secondary to patella baja. In our series, in which an osteotomy was performed with a calibrated osteotomy cutting guide and rigid internal fixation and was followed by early motion, the rate of complications was low and approximately two-thirds of the knees had a good or excellent clinical result at an average of 8.5 years. Conversion to a total knee arthroplasty was accomplished without difficulty in the patients who had this procedure. We highly recommend high tibial osteotomy with a calibrated osteotomy cutting guide, rigid internal fixation, and early motion for patients who wish to continue an active lifestyle.
我们研究了56例患有内侧单髁骨关节炎和内翻畸形的患者，使用校准截骨切割导向器和坚强内固定进行64例产生外翻的高位胫骨截骨术，并早期活动后的结果。长期研究表明，采用U形钉固定并随后石膏固定的高位胫骨截骨术，5年时预期生存率约为85%，10年时为60%（分别在95个膝关节和213个膝关节的研究中）。据我们所知，尚无关于使用校准截骨切割导向器和坚强内固定并早期活动的高位胫骨截骨术的长期报告。
高位胫骨截骨术的指征为内侧单髁骨关节炎和内翻畸形。进行外侧闭合楔形截骨术。对患者进行复查以获得膝关节评分，拍摄双膝关节的侧位X线片，并在患者站立时拍摄患侧膝关节的全长前后位X线片（显示整个下肢，包括髋部和踝部）。
21个膝关节在高位胫骨截骨术后平均65个月接受了全膝关节置换术。其余43个膝关节临床结果良好或优秀，截骨术后平均8.5年时膝关节平均评分为94分。生存分析显示，以转换为全膝关节置换术作为终点，5年时预期生存率为85%，10年时为53%。术后无患者出现低位髌骨。有6例并发症：4例表浅伤口感染、1例浅静脉血栓形成和1例延迟愈合（5个月时愈合）。
高位胫骨截骨术因并发症发生率高、随时间推移疗效丧失以及继发于低位髌骨导致转换为全膝关节置换术困难而受到批评。在我们的系列研究中，采用校准截骨切割导向器和坚强内固定进行截骨术并早期活动，并发症发生率低，平均8.5年时约三分之二的膝关节临床结果良好或优秀。接受该手术的患者转换为全膝关节置换术没有困难。对于希望继续积极生活方式的患者，我们强烈推荐使用校准截骨切割导向器、坚强内固定和早期活动的高位胫骨截骨术。
