Sterett William I, Miller Bruce S, Joseph Thomas A, Rich Valerie J, Bain Elizabeth M
Steadman-Hawkins Research Foundation, Vail, Colorado, USA.
J Knee Surg. 2009 Jan;22(1):13-6. doi: 10.1055/s-0030-1247720.
This study examined whether medial opening wedge osteotomy inadvertently changes posterior tibial slope and whether this change affects range of motion and functional outcomes. Lateral radiographs of 82 knees with varus arthrosis were reviewed to measure posterior tibial slope before and after medial opening wedge high tibial osteotomy. Anterior or posterior cruciate ligament-deficient knees were excluded. Twenty-one osteotomies were performed using distraction osteogenesis/medial external fixator, 26 using acute distraction/Arthrex plate fixation, and 35 using acute distraction/EBI plate fixation. Preoperative and postoperative Lysholm scores and range of motion were recorded. Posterior slope increased from a mean of 12.5 degrees preoperatively to 16.5 degrees postoperatively (P<.01). Fixation types revealed no difference in posterior slope change. Large slope changes had less preoperative knee flexion than did small changes (123 versus 131; P=.012). No significant correlation existed between posterior slope change and postoperative Lysholm scores (r=0.047, P>.05). We found that medial opening wedge osteotomy may alter sagittal alignment by increasing posterior tibial slope.
本研究探讨内侧开口楔形截骨术是否会意外改变胫骨后倾角度，以及这种改变是否会影响活动范围和功能结果。回顾性分析82例内翻性骨关节炎患者膝关节的外侧X线片，测量内侧高位胫骨开口楔形截骨术前、后的胫骨后倾角度。排除前交叉韧带或后交叉韧带损伤的膝关节。其中21例采用牵张成骨/内侧外固定架进行截骨，26例采用急性牵张/Arthrex钢板固定，35例采用急性牵张/EBI钢板固定。记录术前、术后Lysholm评分及活动范围。胫骨后倾角度平均从术前的12.5°增加到术后的16.5°（P<0.01）。不同固定方式在胫骨后倾角度变化上无差异。胫骨后倾角度变化较大者术前膝关节屈曲度小于变化较小者（123°对131°；P=0.012）。胫骨后倾角度变化与术后Lysholm评分之间无显著相关性（r=0.047，P>0.05）。我们发现内侧开口楔形截骨术可能通过增加胫骨后倾角度来改变矢状面排列。
