Closkey R F, Windsor R E
Hospital for Special Surgery, Cornell University Medical Center, New York, NY 10021, USA.
Clin Orthop Relat Res. 2001 Aug(389):51-6. doi: 10.1097/00003086-200108000-00009.
Knee osteotomies realign the knee in an attempt to better distribute forces across the knee. The anatomic and physiologic function of the extensor mechanism, which includes the quadriceps tendon, patella, and patella ligament, may be altered during this procedure. An understanding of these changes is important especially when additional surgery becomes necessary, such as a conversion to a total knee arthroplasty. The current authors discuss patella mechanics and changes in the patella associated with osteotomies about the knee and the influence on normal patella biomechanics. Although patella changes are uncommon after a distal femoral osteotomy, poor total knee arthroplasty outcomes after a high tibial osteotomy attributable to patella alterations exist. Surgical technique during the primary high tibial osteotomy and the conversion to the total knee arthroplasty can reliably improve the final outcome. Rigid internal fixation with early knee mobilization after high tibial osteotomy reduces the incidence of patella baja and improves total knee arthroplasty outcome after a high tibial osteotomy, whereas while patella changes after a distal femoral osteotomy are minimal and largely ignored.
膝关节截骨术旨在通过重新调整膝关节的力线，更好地分散膝关节所承受的力量。在此手术过程中，包括股四头肌肌腱、髌骨和髌韧带在内的伸膝装置的解剖和生理功能可能会发生改变。了解这些变化非常重要，尤其是在需要进行额外手术（如转换为全膝关节置换术）时。本文作者探讨了髌骨力学以及与膝关节截骨术相关的髌骨变化，以及这些变化对正常髌骨生物力学的影响。虽然股骨远端截骨术后髌骨变化并不常见，但由于髌骨改变导致高位胫骨截骨术后全膝关节置换术效果不佳的情况确实存在。初次高位胫骨截骨术及转换为全膝关节置换术时的手术技术能够可靠地改善最终结果。高位胫骨截骨术后采用坚强内固定并早期进行膝关节活动，可降低低位髌骨的发生率，并改善高位胫骨截骨术后全膝关节置换术的效果，而股骨远端截骨术后的髌骨变化极小，在很大程度上被忽视。
