Spahn Gunter, Fritz Jürgen, Albrecht Dirk, Angele Peter, Fickert Stefan, Aurich Matthias, Hofmann Gunther O, Niemeyer Phillip
Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach.
Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena.
Z Orthop Unfall. 2017 Aug;155(4):457-467. doi: 10.1055/s-0043-108649. Epub 2017 May 18.
This multicenter study was aimed to evaluate the coincidence of degenerative knee cartilage lesions with a varus or valgus dysalignment. Furthermore, the frequency of the combined surgery of cartilage treatments and corrective osteotomies are determined. A total of 1778 patients were included in the German CartilageRegistry (deadline 01.08.2016). In 90.6% of patients, the surgeon calculated the alignment by clinical observation. Varus or valgus conditions were measured radiologically in only 56.0%. This study describes patients who underwent treatment of degenerative cartilage lesions with a complete (clinical and radiological) determination of the alignment. The mean mechanical tibia-femur angle (Paley) (mTFA) in clinically neutral extremities was 0.2° (SD 0.6; 0 - 5), in varus cases 5,0° (SD 3.2; 0 - 15), and - 4.7° (SD - 4.0; - 15 - 0) in valgus cases. Varus dysalignment was significantly associated with cartilage lesions in the medial compartment. Valgus dysalignment more frequently occurred in knees with lateral cartilage lesions. Independently of the surgeon's choice of the method of cartilage surgery, in 72.4% of all valgus deformities a corrective osteotomy was performed. Valgus dysalignment was corrected in 50%. In about a quarter of all cases, cartilage lesions are associated with a varus (18.9%) or valgus (4.2%) dysalignment. In a number of cases, the treatment of cartilage lesions should include the addressing of these axial deviations. Still the efficacy of this procedure regarding prognosis and clinical outcome is unclear.
这项多中心研究旨在评估退行性膝关节软骨损伤与内翻或外翻畸形的一致性。此外，还确定了软骨治疗与矫正截骨联合手术的频率。德国软骨登记处（截止日期为2016年8月1日）共纳入了1778例患者。在90.6%的患者中，外科医生通过临床观察计算对线情况。仅56.0%的患者通过影像学测量内翻或外翻情况。本研究描述了接受退行性软骨损伤治疗且对线情况有完整（临床和影像学）测定的患者。临床中立位肢体的平均机械性胫股角（帕利法）（mTFA）为0.2°（标准差0.6；0 - 5），内翻病例为5.0°（标准差3.2；0 - 15），外翻病例为 - 4.7°（标准差 - 4.0； - 15 - 0）。内翻畸形与内侧间室软骨损伤显著相关。外翻畸形更常见于外侧软骨损伤的膝关节。无论外科医生选择何种软骨手术方法，在所有外翻畸形病例中，72.4%进行了矫正截骨术。50%的外翻畸形得到了矫正。在所有病例中，约四分之一的软骨损伤与内翻（18.9%）或外翻（4.2%）畸形相关。在一些病例中，软骨损伤的治疗应包括处理这些轴向偏差。然而，该手术在预后和临床结果方面的疗效尚不清楚。
