Brinkman J-M, Freiling D, Lobenhoffer P, Staubli A E, van Heerwaarden R J
Department of Orthopaedics, Limb Deformity Reconstruction Unit, Sint Maartenskliniek Woerden, Polanerbaan 2, 3447GN, Woerden, Die Niederlande.
Orthopade. 2014 Nov;43(11):988-99. doi: 10.1007/s00132-014-3036-1.
Similar to the reappreciation of high tibial osteotomy (HTO), supracondylar distal femur varus osteotomy (SCO) for lateral compartment osteoarthritis (OA) of the knee has gained renewed interest as new knowledge has become available on the influence of malalignment on the development, progression and symptoms of OA. Furthermore, the less than optimal results of total knee replacement (TKR) in younger patients have also led to renewed interest in joint-preserving treatment options.
Varus SCO has not had the same success or widespread use as valgus HTO. The goal in SCO is similar to HTO, to shift the load from the diseased to the healthy ompartment, in order to reduce pain, improve function and delay placement of a TKR. Valgus OA however occurs much less frequently than varus OA and varus SCO is considered a technically more demanding procedure. In the past the surgical techniques for SCO were mainly dependent on difficult-to-use implants making the procedure more complex. Complication rates related to the failure of fixation up to 16 % have been reported.
The new biplane osteotomy technique fixated with a locking compression plate is very stable; bone healing potential is optimal using this technique and takes 6-8 weeks. Full weight bearing before full bone healing is possible without loss of correction.
In this article patient selection, planning, surgical techniques, stability of fixation and bone healing for SCO are discussed. In the past the surgical techniques for SCO were mainly dependent on difficult to use implants making the procedure more complex. Complication rates related to the failure of fixation of up to 16 % have been reported.
与高位胫骨截骨术（HTO）重新受到重视类似，股骨髁上远端内翻截骨术（SCO）用于治疗膝关节外侧间室骨关节炎（OA）也重新引起了人们的兴趣，因为关于力线不正对OA的发生、发展和症状的影响有了新的认识。此外，全膝关节置换术（TKR）在年轻患者中效果欠佳，这也促使人们重新关注保留关节的治疗方案。
内翻SCO并未像外翻HTO那样取得成功或得到广泛应用。SCO的目标与HTO相似，即将负荷从患病间室转移至健康间室，以减轻疼痛、改善功能并推迟TKR的植入。然而，外翻OA的发生率远低于内翻OA，且内翻SCO被认为是一项技术要求更高的手术。过去，SCO的手术技术主要依赖于难以使用的植入物，这使得手术更加复杂。据报道，固定失败相关的并发症发生率高达16%。
采用锁定加压钢板固定的新型双平面截骨技术非常稳定；使用该技术骨愈合潜力最佳，需要6至8周。在骨完全愈合之前即可完全负重，且不会丢失矫正效果。
本文讨论了SCO的患者选择、手术规划、手术技术、固定稳定性和骨愈合情况。过去，SCO的手术技术主要依赖于难以使用的植入物，这使得手术更加复杂。据报道，固定失败相关的并发症发生率高达16%。
