胫骨腓骨关节疼痛与腓总神经功能障碍：行胫骨近端腓骨关节切开术的闭合楔形胫骨高位截骨术的临床结果。
Proximal tibiofibular joint pain versus peroneal nerve dysfunction: clinical results of closed-wedge high tibial osteotomy performed with proximal tibiofibular joint disruption.
机构信息
Department of Orthopaedics and Traumatology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey.
Department of Orthopaedics and Traumatology, Baskent University Zubeyde Hanim Practice and Research Center, Izmir, Turkey.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2017 Sep;25(9):2936-2941. doi: 10.1007/s00167-016-4066-5. Epub 2016 Mar 12.
PURPOSE
Closed-wedge high tibial osteotomy (CW-HTO) requires shortening of the fibula or the fibular head or disruption of the proximal tibiofibular joint (PTFJ). However, no study has evaluated the proximal tibiofibular joint after the osteotomy. The aim of this study was to investigate the fate of the PTFJ after CW-HTO applied with using PTFJ disruption method.
METHODS
This prospective study included 22 knees of 20 patients who underwent CW-HTO. The mean age of the patients was 50 ± 4 years, and the mean follow-up period was 27.5 ± 14.3 months (12-46 months). The grade of gonarthrosis (Ahlbäck's classification), tibiofemoral alignment and tibial slope angles were measured on radiographs pre- and post-operatively. During the surgery, the PTFJ capsule was released meticulously so as not to injure the peroneal nerve. Tenderness over the PTFJ was recorded preoperatively and at the last follow-up.
RESULTS
No patient had tenderness or pain over PTFJ preoperatively. On the follow-up examinations, tenderness with compression was detected in nine knees with dorsiflexion, in ten with plantar flexion and in nine with neutral position of the ankle, respectively. None of the patients had peroneal nerve injury (including hypesthesia and mild weakness) post-operatively. However, while 11 knees were pain free in all positions of the ankle, seven knees had tenderness over PTFJ both in dorsiflexion and in plantar flexion.
CONCLUSION
CW-HTO using PTFJ disruption provides good clinical results in terms of medial knee pain and corrects the alignment sufficiently while avoiding peroneal nerve injury. However, the results of this study indicated that this technique might result in painful PTFJs. Thus, the surgeon should consider a possibly painful PTFJ, which can be a cause of chronic lateral knee pain when performing this technique.
LEVEL OF EVIDENCE
III.
目的
闭合楔形胫骨高位截骨术（CW-HTO）需要腓骨或腓骨头缩短或破坏胫骨腓骨关节（PTFJ）。然而，尚无研究评估截骨术后 PTFJ 的情况。本研究旨在探讨使用 PTFJ 破坏法行 CW-HTO 后 PTFJ 的结局。
方法
前瞻性研究纳入 20 例 22 膝行 CW-HTO 的患者。患者平均年龄为 50±4 岁，平均随访时间为 27.5±14.3 个月（12-46 个月）。术前和术后通过 X 线片测量膝关节骨关节炎等级（Ahlbäck 分级）、胫股对线和胫骨倾斜角。手术时，仔细松解 PTFJ 囊，以避免损伤腓总神经。术前和末次随访时记录 PTFJ 压痛情况。
结果
术前无患者出现 PTFJ 压痛或疼痛。随访时，分别有 9 膝背屈、10 膝跖屈和 9 膝中立位踝关节存在压痛伴按压，9 膝存在 PTFJ 压痛。所有患者术后均未发生腓总神经损伤（包括感觉减退和轻度无力）。然而，11 膝在所有踝关节位置均无痛，7 膝在背屈和跖屈时均存在 PTFJ 压痛。
结论
采用 PTFJ 破坏法行 CW-HTO 可获得良好的临床效果，能有效缓解膝关节内侧疼痛，纠正对线，同时避免腓总神经损伤。然而，本研究结果表明，该技术可能导致 PTFJ 疼痛。因此，当行该技术时，术者应考虑到可能存在的疼痛 PTFJ，其可能是慢性外侧膝关节疼痛的原因。
证据等级
III 级。
Zotero 插件