Bruce W J, Rooney J, Hutabarat S R, Atkinson M C, Goldberg J A, Walsh W R
Concord Hospital, Hospital Road, Concord, NSW, Australia.
J Orthop Surg (Hong Kong). 2000 Jun;8(1):61-65. doi: 10.1177/230949900000800111.
Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion. When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized. We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside. It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy. The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29 57) and 79.2 postoperatively (range, 67 90), and the mean range of motion was 59.5 degrees preoperatively and 78.0 degrees postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.
无论全膝关节置换术是初次困难手术还是翻修手术，手术显露都可能具有挑战性。为了获得手术显露并改善膝关节屈曲，已经描述并实施了髌骨近端和远端的各种技术。当由于既往手术或严重的术前膝关节屈曲挛缩而无法进行髌骨外翻时，可以采用胫骨结节冠状面截骨术。我们展示了使用胫骨结节冠状面截骨术的成功结果。本系列所涉及的技术基于Whiteside所描述的技术。它包括形成一个包含胫骨结节和胫骨前部的长外侧肌骨膜瓣，同时保持胫骨近端皮质完整。该瓣沿着胫骨向远端延伸10厘米。通过逐渐截断胫骨嵴的前表面来完成操作。在手术结束时用钢丝将结节重新固定。该技术将与胫骨结节截骨术相关的并发症降至最低。对9例接受全膝关节置换术并进行胫骨结节冠状面截骨术的患者的10个膝关节进行了术前和术后评估。所有膝关节均使用特种外科医院膝关节评分（HSS）进行评估。术前评分平均为43.6（范围29 - 57），术后为79.2（范围67 - 90），术前平均活动范围为59.5度，术后为78.0度。没有伸直滞后的病例。术后3例出现固定性屈曲畸形。截骨近端和远端的平均愈合时间分别为8周和24周。没有骨不连的证据，也没有发生其他严重并发症。
