髌骨关节面高度在胫骨高位截骨术的相关性研究。
Patellar height relevance in opening-wedge high tibial osteotomy.
机构信息
Service de chirurgie orthopédique et traumatologique, centre hospitalier intercommunal de Villeneuve-Saint-Georges, 40, allée de la Source, 94190 Villeneuve-Saint-Georges, France.
出版信息
Orthop Traumatol Surg Res. 2010 Feb;96(1):37-43. doi: 10.1016/j.rcot.2009.11.003.
INTRODUCTION
The decrease of patellar height following opening-wedge proximal tibial osteotomy can affect function, and subsequent total knee arthroplasty may be more difficult and give poorer results.
HYPOTHESIS
Pre-operative patellar height is an objective predictor of functional result in opening-wedge osteotomy.
PATIENTS AND METHODS
The effect of opening-wedge high tibial osteotomy (HTO) and internal fixation on patellar height and its functional outcome were assessed. Forty supra-tuberosity medial opening wedge osteotomies were performed in 36 patients presenting with medial femorotibial osteoarthritis and varus deformity. Mean age was 55 years. Mean varus was 9 degrees and mean opening 11 degrees. Minimum follow-up was 22 months, with a mean of 4.2 years. Clinical results were assessed on the International Knee Society (IKS) scale. X-ray measurements (HKA angle, tibial slope, and patellar height as per Caton-Deschamps [CD], Insall-Salvati [IS] and Blackburne-Peel [BP]) were taken pre-operatively, postoperatively and on follow-up.
RESULTS
Patellar height decreased by 10 to 15% (p < 0.0001), depending on the selected ratio. Mean CD index was 0.85 preoperatively (S.D. = 0.12), 0.76 postoperatively (S.D. = 0.14) and 0.75 at follow-up (S.D. = 0.14). Mean IS index was 0.95 preoperatively (S.D. = 0.11), 0.86 postoperatively (S.D. = 0.12) and 0.87 at follow-up (S.D. = 0.12). Mean BP index was 0.68 preoperatively(S.D. = 0.10) and 0.58 postoperatively and at follow-up (S.D. = 0.12). Tibial slope was altered by a mean of 1.5 degrees (range: -4 to + 9 degrees). There was no correlation between opening angle and patellar lowering. Patellar height decrease did not affect functional results whether height remained normal or became low (total IKS score, 179 and 170, respectively); the poorest functional results, however, were associated with patella infera (total score, 147).
DISCUSSION
Medial opening-wedge HTO is an established treatment for unicompartmental varus knee osteoarthritis. We do not, however, recommend it in case of preoperative patellar height of less than 0.6 on the CD ratio.
LEVEL OF EVIDENCE
Retrospective, level IV.
简介
胫骨高位截骨术后髌骨关节高度的降低会影响功能，后续的全膝关节置换术可能会更困难，结果也会更差。
假说
术前髌骨关节高度是胫骨高位截骨术的功能结果的客观预测指标。
患者和方法
评估了胫骨高位截骨术（HTO）和内固定对内侧髌骨关节高度及其功能结果的影响。36 例患有内侧股胫关节炎和内翻畸形的患者接受了 40 例胫骨结节上内侧开放楔形截骨术。平均年龄为 55 岁。平均内翻 9 度，平均开口 11 度。最短随访时间为 22 个月，平均随访时间为 4.2 年。临床结果采用国际膝关节学会（IKS）评分进行评估。术前、术后和随访时拍摄 X 线片（HKA 角、胫骨倾斜度和髌骨关节高度，根据 Caton-Deschamps [CD]、Insall-Salvati [IS] 和 Blackburne-Peel [BP] 测量）。
结果
髌骨关节高度降低了 10%至 15%（p<0.0001），具体取决于所选比值。术前 CD 指数为 0.85（标准差[SD]=0.12），术后为 0.76（SD=0.14），随访时为 0.75（SD=0.14）。术前 IS 指数为 0.95（SD=0.11），术后为 0.86（SD=0.12），随访时为 0.87（SD=0.12）。术前 BP 指数为 0.68（SD=0.10），术后和随访时为 0.58（SD=0.12）。胫骨倾斜度平均改变 1.5 度（范围：-4 度至+9 度）。开口角度与髌骨关节降低之间没有相关性。髌骨关节高度降低不会影响功能结果，无论高度是否正常或降低（总 IKS 评分分别为 179 和 170）；然而，髌骨关节高度最低与髌骨关节低位（总分 147）相关。
讨论
内侧开放楔形 HTO 是治疗单间室内翻膝关节骨关节炎的一种既定方法。然而，如果术前 CD 比值的髌骨关节高度小于 0.6，则不建议使用该方法。
证据水平
回顾性，IV 级。
Zotero 插件