Albert-Trillat Surgical Center, North Lyon Teaching Hospital Center, Lyon 1 Claude-Bernard University, 8, rue des Margnolles, 69300 Caluire-et-Cuire, France.
Orthop Traumatol Surg Res. 2010 Dec;96(8):856-60. doi: 10.1016/j.otsr.2010.06.012. Epub 2010 Nov 5.
Osteotomies to address lower extremity post-traumatic deformities are more complex than standard osteotomies performed for congenital deformities, standard osteotomies and their outcomes are not well known. We performed a multicentric retrospective study of these cases. We hypothesized that osteotomy without total knee replacement to correct fracture malunion deformities can provide long-term relief from athritic pain.
Twenty-eight patients, mean age 46.4 years old, underwent, between 2000 and 2008, osteotomy for post traumatic osteoarthritis which had resulted in intraarticular malunion in six patients and extraarticular malunion in 22 cases. The initial trauma had occurred a mean 17.3 years before. There were 11 valgus and 17 varus deformities. Two osteotomies were performed in the callus to correct intraarticular malunion. The other osteotomies were performed outside the callus: in 25 cases to correct coronal plane deformities (nine tibial, 11 femoral and five tibial and femoral), including nine cases with associated derotation. Osteotomies were performed on the distal femoral metaphysis and the proximal tibia. There was also one case of supramalleolar derotation osteotomy of the tibia. All 28 patients were contacted again for a consultation. There was a postoperative clinical and radiographic follow-up of at least 2years for all patients despite four lost to follow-up patients. There were 18 patients with Ahlback grade 2 arthritis, nine grade 3 and one grade 4.
Two patients with an intraarticular malunion finally underwent revision surgery to receive total knee replacement because of persistent pain. These patients had grade 3 and 4 arthritis respectively and undercorrection persisted in the coronal plane. Four patients underwent repeated surgery for stiffness, early infection treated with debridement and antibiotics as well as femoral pseudarthrosis (two cases). After a mean follow-up of 3.8 years, the pain score had improved significantly with more marked improvement in extraarticular malunions (P=0.03). Functional improvement was moderate (equivalent in patients with Ahlback grades 2 and 3 arthritis) and articular range of motion did not change. Osteotomy corrected valgus and varus deformities with a mean realignment effect of 9° and 10° respectively.
Osteotomy should correct the three components of the traumatic deformity at the distal femoral metaphysic level to allow mechanical axis and rotation anomalies correction, and at the proximal tibia level for realignment purposes. Supramalleolar tibial osteotomy should be performed for tibial derotation. Pain relief with osteotomy had better outcomes when dealing with extraarticular malunions. In unicompartmental grade 2 and 3 arthritis, the indications can be fairly broad in young patients. Besides providing temporary relief, osteotomy facilitates future total knee replacement surgery in these cases.
Level 4; non controlled, retrospective study.
下肢创伤后畸形的截骨术比先天性畸形的标准截骨术更为复杂，标准截骨术及其结果尚不清楚。我们对这些病例进行了多中心回顾性研究。我们假设，不进行全膝关节置换而进行截骨术来纠正骨折愈合不良畸形，可以长期缓解关节炎疼痛。
2000 年至 2008 年间，28 例患者因创伤后骨关节炎行截骨术，其中 6 例为关节内愈合不良，22 例为关节外愈合不良。最初的创伤发生在平均 17.3 年前。有 11 例外翻和 17 例内翻畸形。2 例行骨痂内截骨术以纠正关节内愈合不良。其他截骨术在骨痂外进行：25 例用于矫正冠状面畸形（9 例胫骨、11 例股骨和 5 例胫骨和股骨），其中 9 例伴有旋转畸形。截骨术在股骨远端干骺端和胫骨近端进行。还有 1 例胫骨高位截骨术。所有 28 例患者均再次进行了咨询。尽管有 4 例患者失访，但所有患者均进行了至少 2 年的术后临床和影像学随访。18 例患者为 Ahlback 关节炎 2 级，9 例为 3 级，1 例为 4 级。
由于持续疼痛，两名关节内愈合不良的患者最终接受了全膝关节置换术的翻修手术。这两名患者分别为关节炎 3 级和 4 级，冠状面矫正不足仍持续存在。4 例患者因僵硬而再次手术，早期感染采用清创和抗生素治疗，还有 2 例发生股骨假关节。平均随访 3.8 年后，疼痛评分显著改善，关节外愈合不良的改善更为明显（P=0.03）。功能改善为中度（关节炎 2 级和 3 级患者相似），关节活动度无变化。截骨术矫正了外翻和内翻畸形，平均矫正效果分别为 9°和 10°。
截骨术应纠正股骨远端干骺端的三个创伤畸形成分，以矫正机械轴和旋转异常，并在胫骨近端进行矫正。胫骨高位截骨术应用于胫骨旋转。对于关节外愈合不良，截骨术可获得更好的疼痛缓解效果。在单间室关节炎 2 级和 3 级患者中，年轻患者的适应证可相当广泛。除了提供暂时的缓解外，截骨术还为这些病例的全膝关节置换术提供了便利。
4 级；非对照、回顾性研究。
