Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany.
Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2766-2773. doi: 10.1007/s00167-017-4731-3. Epub 2017 Oct 3.
High tibial osteotomy (HTO) has gained more importance in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. Concerning the extent of axis correction, various different views exist. The aim of this study was to evaluate the effect of the size of axis correction on functional outcome in patients undergoing a valgus HTO.
From 2005 to 2013, 156 patients with an underlying varus deformity and cartilage damages or unicompartimental osteoarthritis of the medial compartment were treated by HTO. Retrospectively patients were allocated into three different groups according to the degree of axis correction. For this purpose, three adjacent areas, respectively, comprising 5% of the tibial plateau were defined. Limits of those areas were set as follows: with the medial border representing the 0% point and the lateral border representing the 100 point, the three areas were separated according to their limiting intersection points (group A 50-55%, group B 55-60%, group C > 60%). For comparison of the functional outcomes, standardized measures and scores were used (pre-OP: VAS, Lysholm; post-OP: VAS, Lysholm, KOOS). Analysis of the pre- and post-operatively recorded X-rays was effected by means of a planning software (mediCAD, Hectec GmbH, Germany), and statistical analysis was carried out using SPSS Statistics 21.0 (IBM Corp., Armonk, USA). A p value of 0.05 was considered statistically significant.
Thirty-nine patients were allocated to group A, 50 patients to group B and 67 to group C. Pre-operatively, patients in each group were of a homogenous constitution. In the groups A-C, HTO proved to reduce the VAS score and to increase the Lysholm score (p < 0.001). Regarding outcome parameters, group A showed significantly better results in terms of increased Lysholm (p = 0.049) and KOOS pain score (p = 0.043). In patients treated by HTO and ACI implantation for medial compartment lesions, the best results were achieved in group A which was of statistical significance in comparison of the Lysholm (p = 0.006) and VAS score (p = 0.045) of groups A and C. In this subgroup, the size of the post-operative valgus angle significantly correlated with the final VAS score (PC 0.364; p = 0.013), final Lysholm score (PC - 0.390; p = 0.007) and KOOS4 (PC - 0.356; p = 0.014).
HTO for varus deformity in patients with concomitant cartilage damage or osteoarthritis of the medial compartment is a reliable treatment option with satisfying functional outcome. Precise pre-operative planning regarding individual factors in each patient is mandatory; a pathology-based extent of correction leads to a favourable clinical outcome and to a significant reduction in pain.
Retrospective cohort study, Level III.
在治疗伴有内侧间室软骨损伤或骨关节炎的外侧畸形的情况下，高位胫骨截骨术（HTO）变得更加重要。关于轴矫正的程度，存在各种不同的观点。本研究的目的是评估在行外翻 HTO 时，轴矫正程度对功能结果的影响。
2005 年至 2013 年，156 例存在内侧畸形伴软骨损伤或内侧单室骨关节炎的患者接受了 HTO 治疗。回顾性地，根据轴矫正的程度将患者分为三组。为此，分别定义了三个相邻的区域，每个区域占胫骨平台的 5%。这些区域的界限如下：内侧边界代表 0%点，外侧边界代表 100 点，根据限制交点将三个区域分开（组 A 50-55%，组 B 55-60%，组 C > 60%）。为了比较功能结果，使用了标准化的测量和评分（术前：VAS、Lysholm；术后：VAS、Lysholm、KOOS）。使用规划软件（mediCAD，Hectec GmbH，德国）对术前和术后记录的 X 射线进行分析，并使用 SPSS Statistics 21.0（IBM Corp.，Armonk，USA）进行统计分析。p 值<0.05 被认为具有统计学意义。
39 例患者被分配到组 A，50 例患者被分配到组 B，67 例患者被分配到组 C。每组患者术前均具有同质的构成。在 A-C 组中，HTO 被证明可降低 VAS 评分并增加 Lysholm 评分（p<0.001）。在术后的参数中，组 A 在增加的 Lysholm（p=0.049）和 KOOS 疼痛评分（p=0.043）方面表现出明显更好的结果。在接受 HTO 和内侧腔隙 ACI 植入治疗的患者中，组 A 的结果最佳，在比较组 A 和 C 的 Lysholm（p=0.006）和 VAS 评分（p=0.045）时具有统计学意义。在该亚组中，术后外翻角的大小与最终的 VAS 评分（PC 0.364；p=0.013）、最终的 Lysholm 评分（PC-0.390；p=0.007）和 KOOS4（PC-0.356；p=0.014）显著相关。
在伴有内侧软骨损伤或骨关节炎的内侧畸形患者中，HTO 是一种可靠的治疗选择，具有令人满意的功能结果。对每位患者的个体因素进行精确的术前规划是必要的；基于病理学的矫正程度可导致良好的临床结果和疼痛的显著减轻。
回顾性队列研究，III 级。
Zotero 插件