Ihle C, Ahrend M, Grünwald L, Ateschrang A, Stöckle U, Schröter S
Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany.
Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany.
Knee. 2017 Oct;24(5):1118-1128. doi: 10.1016/j.knee.2017.06.006. Epub 2017 Jun 30.
Open wedge high tibial osteotomy (HTO) can influence the tibial slope and thereby the landmarks of currently used patellar height indices. The purpose of this retrospective study was to compare and validate a new femur-referenced patella height measurement method to currently used patellar height indices in a cohort of HTO patients.
Patellar height (Caton-Deschamps, Blackburne-Peel and Insall-Salvati Indices and our newly developed Femoral Patellar Height Index) as well as tibial slope were analysed. Full-weight-bearing long-leg anteroposterior radiographs as well as anteroposterior and lateral radiographs of the knee in 0° of extension were used. Radiographs were performed preoperatively, and at six weeks, three, six, 12 and 18months postoperatively. Measurements were recorded twice by two observers. The second observation was performed after a delay of three months.
A total of 99 patients with a mean age of 46.2±8years were included. A statistically significant pre- to postoperative increase in tibial slope was found in all methods. Patellar height decreased according to Caton-Deschamps and Blackburne-Peel Indices. The Insall-Salvati Index as well as the novel Femoral Patellar Height Index remained unchanged. Intra-rater (interclass correlation coefficient (ICC) 0.914-0.998) and inter-rater (ICC 0.955-0.989) reliability were highest in the new index.
Detected changes of patellar height following open wedge HTO depend on the method used. Tibial slope increases following surgery. Our new index with a femoral reference for measuring patellar height was validated and good to excellent intra- and inter-rater reliability were demonstrated. Following HTO, the Femoral Patellar Height Index can be recommended as a standardized method to measure patellar height.
开放性楔形高位胫骨截骨术（HTO）可影响胫骨坡度，进而影响当前使用的髌股高度指数的参考标志。本回顾性研究的目的是在一组HTO患者中，将一种新的以股骨为参考的髌股高度测量方法与目前使用的髌股高度指数进行比较和验证。
分析髌股高度（卡顿 - 德尚指数、布莱克本 - 皮尔指数、英萨尔 - 萨尔瓦蒂指数以及我们新开发的股骨髌股高度指数）和胫骨坡度。使用全负重长腿前后位X线片以及膝关节在伸直0°时的前后位和侧位X线片。术前以及术后6周、3个月、6个月、12个月和18个月进行X线片检查。测量由两名观察者记录两次。第二次观察在三个月后进行。
共纳入99例平均年龄为46.2±8岁的患者。所有方法均显示术后胫骨坡度较术前有统计学意义的增加。根据卡顿 - 德尚指数和布莱克本 - 皮尔指数，髌股高度降低。英萨尔 - 萨尔瓦蒂指数以及新的股骨髌股高度指数保持不变。新指数的组内（组内相关系数（ICC）为0.914 - 0.998）和组间（ICC为0.955 - 0.989）可靠性最高。
开放性楔形HTO术后检测到的髌股高度变化取决于所使用的方法。术后胫骨坡度增加。我们新的以股骨为参考测量髌股高度的指数得到了验证，并且组内和组间可靠性良好至优秀。HTO术后，股骨髌股高度指数可作为测量髌股高度的标准化方法推荐使用。
