Trevor B. Birmingham, and J. Robert Giffin, FRCS(C Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario N6A 3K7, Canada.
Am J Sports Med. 2013 Dec;41(12):2849-57. doi: 10.1177/0363546513505077. Epub 2013 Sep 27.
Medial opening wedge high tibial osteotomy (HTO) for the treatment of varus gonarthrosis can be associated with inadvertent decreases in patellar height.
Decreases in patellar height observed after medial opening wedge HTO can be minimized with the addition of a tibial tubercle osteotomy (TTO).
Cohort study; Level of evidence, 3.
Twenty-nine patients undergoing medial opening wedge HTO with a concurrent TTO were matched with 29 controls who previously underwent medial opening wedge HTO without a TTO. Both groups had substantial varus malalignment (mean mechanical axis angle, -10° ± 3°) requiring large corrections. Measurements of patellar height and posterior tibial slope were calculated from standing lateral radiographs and compared preoperatively and 6 months postoperatively. Patellar height measures included the Blackburne-Peel index, Caton-Deschamps index, Miura-Kawamura index, Insall-Salvati ratio, and modified Insall-Salvati ratio.
The changes in the Blackburne-Peel, Caton-Deschamps, and Miura-Kawamura indices were significantly less in the HTO/TTO group versus the HTO group. There were 3 of 29 (10%) new cases that met the radiographic criteria for patella infera in the HTO/TTO group versus 11 of 29 (38%) new cases of patella infera found postoperatively in the HTO group, suggesting an absolute risk reduction of 28% with TTO. The changes in the Blackburne-Peel and Caton-Deschamps indices were correlated to a larger preoperative varus deformity in the coronal plane (r = 0.52 and r = 0.41, respectively).
The addition of a TTO when performing a medial opening wedge HTO minimizes the decreases in patellar height associated with the procedure.
内侧开放楔形胫骨高位截骨术（HTO）治疗内翻性膝关节炎可能会导致髌骨高度意外降低。
在进行内侧开放楔形 HTO 时，增加胫骨结节截骨术（TTO）可以最大限度地减少髌骨高度的降低。
队列研究；证据水平，3 级。
29 例接受内侧开放楔形 HTO 联合 TTO 的患者与 29 例先前接受内侧开放楔形 HTO 而未行 TTO 的对照患者相匹配。两组均有严重的内翻畸形（平均机械轴角度，-10°±3°），需要较大的矫正。从站立位侧位 X 线片上计算髌骨高度和胫骨后倾角的测量值，并与术前和术后 6 个月进行比较。髌骨高度测量包括 Blackburne-Peel 指数、Caton-Deschamps 指数、Miura-Kawamura 指数、Insall-Salvati 比和改良 Insall-Salvati 比。
与 HTO 组相比，HTO/TTO 组的 Blackburne-Peel、Caton-Deschamps 和 Miura-Kawamura 指数的变化明显更小。HTO/TTO 组中有 3 例（10%）符合髌骨下极的影像学标准，而 HTO 组中有 11 例（38%）术后出现髌骨下极，提示 TTO 可降低 28%的绝对风险。Blackburne-Peel 和 Caton-Deschamps 指数的变化与冠状面更大的术前内翻畸形相关（r=0.52 和 r=0.41）。
在进行内侧开放楔形 HTO 时，增加 TTO 可最大限度地减少与该手术相关的髌骨高度降低。
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