Orthopaedic Department, Hôpital André Mignot, 177, rue de Versailles, 78157, Le Chesnay, France.
Knee Surg Sports Traumatol Arthrosc. 2013 Jan;21(1):255-9. doi: 10.1007/s00167-012-2304-z. Epub 2012 Nov 25.
High valgus tibial osteotomy is used to treat medial femoro-tibial osteoarthritis. Changes in patellar height due to high valgus tibial osteotomy can cause technical difficulties during subsequent knee arthroplasty. The primary objective of this study was to assess the hypothesis that patellar height decreases after opening-wedge osteotomy and increases after closing-wedge osteotomy. The secondary objective was to assess whether frontal axis correction and tibial slope modification correlated with patellar height changes.
A multicentre, prospective, comparative, observational, non-randomised study was conducted in consecutive patients undergoing isolated high valgus tibial osteotomy according to standard practice in each of the ten study centres. Patellar height was assessed based on the Caton-Deschamps index.
Of 321 included patients, 224 underwent opening-wedge and 97 closing-wedge osteotomy. Patellar height did not change significantly after closing-wedge osteotomy (1.07 ± 0.2 pre-operatively and 1.0 ± 0.19 postoperatively). Patellar height decreased significantly after opening-wedge osteotomy (from 0.98 ± 0.19 to 0.88 ± 0.21, p < 0.0001, mean decrease 9 ± 22%). Patellar height decreased by more than 20% in 49 (28%) patients after opening-wedge osteotomy. The patellar height decrease after opening-wedge osteotomy correlated significantly with axis correction magnitude and tibial slope change.
Our results support routine baseline measurement of patellar height before high valgus tibial osteotomy and posterior positioning of the opening wedge to limit the tibial slope change in patients requiring major axis correction by opening-wedge osteotomy.
Prospective cohort study, Level II.
胫骨高位截骨术用于治疗内侧股胫关节炎。由于胫骨高位截骨术导致的髌骨高度变化可能会在随后的膝关节置换术中造成技术困难。本研究的主要目的是评估以下假设，即开放式楔形截骨术后髌骨高度降低，而闭合式楔形截骨术后髌骨高度增加。次要目的是评估额状面轴校正和胫骨倾斜度改变是否与髌骨高度变化相关。
这是一项多中心、前瞻性、对照、观察性、非随机研究，在 10 个研究中心的标准实践中连续纳入接受单纯高位胫骨截骨术的患者。根据 Caton-Deschamps 指数评估髌骨高度。
321 例患者中，224 例行开放式楔形截骨术，97 例行闭合式楔形截骨术。闭合式楔形截骨术后髌骨高度无明显变化（术前 1.07 ± 0.2，术后 1.0 ± 0.19）。开放式楔形截骨术后髌骨高度显著降低（从 0.98 ± 0.19 降至 0.88 ± 0.21，p < 0.0001，平均下降 9 ± 22%）。49 例（28%）患者术后髌骨高度下降超过 20%。开放式楔形截骨术后髌骨高度下降与轴校正幅度和胫骨倾斜度改变显著相关。
我们的结果支持在进行高位胫骨截骨术之前常规测量髌骨高度，并在后侧放置开口楔形物，以限制需要通过开放式楔形截骨术进行主要轴校正的患者的胫骨倾斜度改变。
前瞻性队列研究，II 级。
