Flecher Xavier, Parratte Sebastien, Aubaniac Jean-Manuel, Argenson Jean-Noël A
Aix-Marseille University, Department of Orthopedic Surgery, Hôpital Sainte-Marguerite, Marseille, France.
Clin Orthop Relat Res. 2006 Nov;452:91-6. doi: 10.1097/01.blo.0000229362.12244.f6.
Current indications for high tibial osteotomy (HTO) are controversial although several risk factors have been associated with HTO survival. We ascertained the influence of preoperative variables in a consecutive series of patients who had closing wedge HTO at a minimum of 12 year followup (mean 18-year, range 12 to 28 years). Three hundred one of an initial 372 high tibial osteotomies (313 patients) were included (81% followup); 71 knees were eliminated because patients died (30 knees) or were lost to followup (41 knees). The mean age was 42 years (range, 15-76 years), 194 were men and 119 were women. The osteotomy was fixed by a Blount staple and an AO half-tube plate with three screws. Forty-three knees (14%) in 39 patients were revised for progression of osteoarthritis at an average of 102 months. Survival was 85% at 20 years with revision as the endpoint. Knee function was considered satisfactory by 77% of patients. At final followup, 1/2 of the knees showed radiographic signs of medial osteoarthritis. The most important risk factors predicting revision were age greater than 50 years and a preoperative arthritis Ahlback grade of 3 or more.
尽管有几个风险因素与高位胫骨截骨术（HTO）的预后相关，但目前HTO的适应症仍存在争议。我们在一组连续的患者中确定了术前变量的影响，这些患者均接受了闭合楔形HTO手术，且至少随访了12年（平均18年，范围12至28年）。最初的372例高位胫骨截骨术（313例患者）中有301例被纳入研究（随访率81%）；71例膝关节被排除，原因是患者死亡（30例）或失访（41例）。平均年龄为42岁（范围15至76岁），男性194例，女性119例。截骨术采用布朗特钉和带三枚螺钉的AO半管形钢板固定。39例患者中的43个膝关节（14%）因骨关节炎进展而进行了翻修，平均时间为102个月。以翻修为终点，20年生存率为85%。77%的患者认为膝关节功能令人满意。在最后一次随访时，半数膝关节显示出内侧骨关节炎的影像学征象。预测翻修的最重要风险因素是年龄大于50岁和术前关节炎Ahlback分级为3级或更高。
