Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, N6A 3K7, Canada,
Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2672-81. doi: 10.1007/s00167-013-2559-z. Epub 2013 Jun 13.
(1) To evaluate the effect of staged bilateral medial opening wedge high tibial osteotomy (HTO) on established biomechanical risk factors for disease progression and on validated measures of pain and function and (2) To compare outcomes in patients having the second surgery staged within or beyond 12 months of the first surgery.
Thirty-seven patients with bilateral varus alignment and medial compartment osteoarthritis underwent staged bilateral medial opening wedge HTO (21 within and 16 beyond 12 months). Patients underwent full-limb standing anteroposterior radiographs to determine frontal plane alignment (mechanical axis angle) and three-dimensional gait analysis to estimate the distribution of load across the tibiofemoral compartments (external knee adduction moment). Patients also completed the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), the Lower Extremity Functional Scale, the Short Form Health Survey and the six-minute walk test (6MWT). Patients (both limbs) were evaluated before and approximately 6, 12 and 24 months after each surgery.
There were statistically and clinically significant changes in both limbs that were of similar magnitudes and that remained relatively stable over time postoperatively. Mean (95% CI) improvements in outcomes were as follows. Mechanical axis angle: 9.4° (8.4°, 10.4°) (i.e. average change of both limbs), peak knee adduction moment: -1.7%BWHt (-2.1, -1.4 %BWHt) (i.e. average change of both limbs), 6MWT: 36.7 m (19.4, 54.0 m), SF-12 Physical Component Summary: 12.0 (8.5, 15.5) and KOOS Pain: 25.4 (19.6, 31.2). Other than the shorter time period to reach maximum benefit of both surgeries, there were no remarkable differences at final assessment between patients having surgeries staged within or beyond 12 months.
The present findings demonstrate that patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally (mechanical axis angles and external knee adduction moments), as well as clinically important improvements in patient-important outcomes, after staged medial opening wedge HTO. Current findings suggest no difference in outcomes for patients who have the second surgery staged within or beyond 12 months of the first surgery.
IV.
（1）评估分期双侧内侧开放楔形胫骨高位截骨术（HTO）对已确立的疾病进展生物力学危险因素的影响，以及对验证的疼痛和功能测量的影响；（2）比较分期双侧内侧开放楔形胫骨高位截骨术的患者中，第二期手术在第一期手术后 12 个月内或 12 个月后进行的结果。
37 例双侧内翻畸形伴内侧间室骨关节炎患者接受分期双侧内侧开放楔形胫骨高位截骨术（21 例在 12 个月内，16 例在 12 个月后）。患者接受全下肢站立前后位 X 线片以确定额状面排列（机械轴角度）和三维步态分析以估计胫骨股骨间室的负荷分布（膝关节外侧内收力矩）。患者还完成了膝关节损伤和骨关节炎结果评分（KOOS）、下肢功能量表、简明健康调查问卷和 6 分钟步行测试（6MWT）。患者（双侧肢体）在每一次手术后大约 6、12 和 24 个月前进行评估。
在双侧肢体中，均有统计学和临床意义上的显著变化，且术后随时间推移相对稳定。术后结果的平均（95%CI）改善情况如下。机械轴角度：9.4°（8.4°，10.4°）（即双侧肢体的平均变化），峰值膝关节内收力矩：-1.7%BWHt（-2.1%，-1.4%BWHt）（即双侧肢体的平均变化），6MWT：36.7m（19.4，54.0m），SF-12 生理成分综合评分：12.0（8.5，15.5），KOOS 疼痛评分：25.4（19.6，31.2）。除了两次手术达到最大获益的时间间隔较短外，在最终评估中，12 个月内或 12 个月后分期手术的患者之间没有明显差异。
本研究结果表明，双侧内侧开放楔形胫骨高位截骨术治疗双侧内翻性膝关节炎患者的已确立疾病进展生物力学危险因素（机械轴角度和膝关节外侧内收力矩）可显著改善，以及患者重要结局的临床重要改善，分期内侧开放楔形胫骨高位截骨术后。目前的研究结果表明，第二期手术在第一期手术后 12 个月内或 12 个月后进行的患者，其结果无差异。
IV。
