Brouwer R W, Bierma-Zeinstra S M A, van Koeveringe A J, Verhaar J A N
Erasmus Medical Centre, Rotterdam, The Netherlands.
J Bone Joint Surg Br. 2005 Sep;87(9):1227-32. doi: 10.1302/0301-620X.87B9.15972.
Our aim was to compare the degree of patellar descent and alteration in angle of the inclination of the tibial plateau in lateral closing-wedge and medial opening-wedge high tibial osteotomy (HTO) in 51 consecutive patients with osteoarthritis of the medial compartment and varus malalignment. Patellar height was measured by the Insall-Salvati (IS) and the Blackburne-Peel (BP) ratios. The tibial inclination was determined by the Moore-Harvey (MH) method. Multivariate linear regression analysis was used to determine the influence of the type of HTO (closing vs opening wedge) on the post-operative patellar height or tibial inclination. The intra- and interobserver variability of these methods was determined before operation and at follow-up at one year. After an opening-wedge HTO the patellar height was significantly more decreased (mean post-operative difference: IS = 0.15; 95% confidence interval (CI) 0.06 to 0.23; BP = 0.11; 95% CI 0.05 to 0.18) compared with a closing-wedge HTO. The angle of tibial inclination differed significantly (mean post-operative difference MH = -6.40 degrees; 95% CI -8.74 to -4.02) between the two HTO techniques, increasing after opening-wedge HTO and decreasing after closing-wedge HTO. There was no clinically-relevant difference in the intra- and interobserver variability of measurements of patellar height either before or after HTO.
我们的目的是比较51例连续的内侧间室骨关节炎合并内翻畸形患者，在外侧闭合楔形和内侧开放楔形高位胫骨截骨术（HTO）中髌骨下降程度和胫骨平台倾斜角度的改变。通过Insall-Salvati（IS）和Blackburne-Peel（BP）比率测量髌骨高度。采用Moore-Harvey（MH）方法确定胫骨倾斜度。使用多变量线性回归分析来确定HTO类型（闭合楔形与开放楔形）对术后髌骨高度或胫骨倾斜度的影响。在手术前和术后一年随访时确定这些方法的观察者内和观察者间变异性。与闭合楔形HTO相比，开放楔形HTO后髌骨高度显著降低更多（术后平均差异：IS = 0.15；95%置信区间（CI）0.06至0.23；BP = 0.11；95%CI 0.05至0.18）。两种HTO技术之间胫骨倾斜角度有显著差异（术后平均差异MH = -6.40度；95%CI -8.74至-4.02），开放楔形HTO后增加，闭合楔形HTO后减少。HTO前后髌骨高度测量的观察者内和观察者间变异性在临床上没有相关差异。
