Belmont Philip J, Fisher Tuesday F, Bader Julia M, Lanzi Joseph T, Owens Brett D, Waterman Brian R
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas.
J Knee Surg. 2018 Apr;31(4):306-313. doi: 10.1055/s-0037-1603639. Epub 2017 Jun 15.
This article sought to determine rates for return to work, pain relief, and recurrent patellofemoral instability for military service members undergoing tibial tubercle osteotomy (TTO) for persistent lateral patellar subluxation or dislocation. Patient demographic and surgical variables were isolated from the medical records of active duty service members with at least 2 years of postoperative follow-up, and correlated with return to work, pain improvement, recurrent patellofemoral instability, and perioperative complications. There were 51 service members (58 primary TTOs) with an average follow-up of 3.3 (range, 2.0-6.7) years. Service members had an average of 2.8 (1-12) instability events preoperatively. At a minimum of 2 years postoperatively, 41 (80%) military service members returned to full active duty service. Among the 58 TTOs, there was a 46% improvement in the patient-reported visual analog score from 4.1 to 2.2 ( < 0001). The postoperative recurrent instability rates were patellar dislocation (5.1%) and patellar subluxation (15.5%). Concomitant proximal realignment was performed in 48% of cases, which did not affect return to service, postoperative patellar instability events, or pain improvement ( > 0.05). The overall complication rate was 10%. Postoperative tibial fractures occurred in 6.9% of TTOs. At short- to mid-term follow-up, 80% of service members undergoing TTO for patellofemoral instability returned to military duty with significant improvement in pain scores and a moderate perioperative complication and postoperative instability rate. This study is a level IV therapeutic case series.
本文旨在确定因持续性外侧髌骨半脱位或脱位而接受胫骨结节截骨术（TTO）的军人恢复工作的比率、疼痛缓解情况以及复发性髌股关节不稳定的发生率。从至少有2年术后随访的现役军人的医疗记录中提取患者人口统计学和手术变量，并将其与恢复工作情况、疼痛改善情况、复发性髌股关节不稳定以及围手术期并发症进行关联分析。共有51名军人（58例初次TTO手术），平均随访时间为3.3年（范围为2.0 - 6.7年）。军人术前平均有2.8次（1 - 12次）不稳定事件。术后至少2年时，41名（80%）军人恢复了全勤现役。在58例TTO手术中，患者报告的视觉模拟评分从4.1改善至2.2，改善率为46%（P < 0.0001）。术后复发性不稳定发生率为髌骨脱位（5.1%）和髌骨半脱位（15.5%）。48%的病例同时进行了近端重新排列，这对恢复服役、术后髌股关节不稳定事件或疼痛改善没有影响（P > 0.05）。总体并发症发生率为10%。6.9%的TTO手术出现了术后胫骨骨折。在短期至中期随访中，80%因髌股关节不稳定接受TTO手术的军人恢复了军事任务，疼痛评分有显著改善，围手术期并发症和术后不稳定发生率中等。本研究为IV级治疗性病例系列。
