Iorio Raffaele, Vadalà Antonio, Giannetti Silvio, Pagnottelli Marco, Di Sette Priscilla, Conteduca Fabio, Ferretti Andrea
Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome, Sapienza, Italy.
Orthopedics. 2010 Oct;33(10 Suppl):82-6. doi: 10.3928/01477447-20100510-54.
Open-wedge high tibial osteotomy (HTO) is an established technique for the treatment of symptomatic varus malaligned knees. In this study, we prospectively followed up 13 patients (14 knees) who underwent navigation system-supported HTO for varus knee deformity. Preoperatively all patients underwent a physical examination, and anteroposterior and laterolateral lower limb weight-bearing digital radiographs were obtained. The following parameters were examined: (1) Insall-Salvati index; (2) posterior tibial slope angle; (3) mechanical femorotibial angle; (4) inferior limb length. At a mean follow-up of 12.6 months, clinical examination showed satisfactory results in all patients. The mean Modified Cincinnati Rating System Questionnaire rating increased significantly from 46.5 ± 7.2 to 84.6 ± 8, while the mean Knee Society Score increased significantly from 51.4 ± 9.9 to 85.1 ± 7.3. The mean Insall-Salvati index changed from 1.11 preoperatively to 1.10 postoperatively (P=.742). According to the navigation system data, the femorotibial mechanical axis was corrected from a varus of 6.3° ± 1.9° to a valgus of 2.1° ± 1.6°. These data matched postoperative radiographic lower limb weight-bearing data. In the group of patients in whom we evaluated the posterior tibial slope with the navigation system, we detected an increase of 0.3° ± 0.4° compared with the preoperative radiographic examination evaluations; the comparison between the postoperative and the preoperative radiograhic examination results showed an increase of 0.5° ± 0.7° (P=.87). The results of our study seem to show greater accuracy of mechanical axis correction and smaller increase in tibial slope when a navigation system is used in open-wedge HTO.
开放楔形高位胫骨截骨术（HTO）是治疗有症状的膝内翻畸形膝关节的一种成熟技术。在本研究中，我们对13例（14膝）接受导航系统辅助的HTO治疗膝内翻畸形的患者进行了前瞻性随访。术前所有患者均接受体格检查，并获得下肢前后位和内外侧负重数字化X线片。检查了以下参数：（1）Insall-Salvati指数；（2）胫骨后倾角度；（3）机械性股胫角；（4）下肢长度。平均随访12.6个月时，临床检查显示所有患者结果均令人满意。改良辛辛那提评分系统问卷评分均值从46.5±7.2显著提高至84.6±8，而膝关节协会评分均值从51.4±9.9显著提高至85.1±7.3。Insall-Salvati指数均值从术前 的1.11变为术后的1.10（P = 0.742）。根据导航系统数据，股胫机械轴从6.3°±1.9°的内翻矫正为2.1°±1.6°的外翻。这些数据与术后下肢负重X线片数据相符。在我们使用导航系统评估胫骨后倾的患者组中，与术前X线检查评估相比，我们检测到增加了0.3°±0.4°；术后与术前X线检查结果比较显示增加了0.5°±0.7°（P = 0.87）。我们的研究结果似乎表明，在开放楔形HTO中使用导航系统时，机械轴矫正的准确性更高，胫骨斜率增加更小。
