Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas.
Health and Human Performance, University of Houston, Houston, Texas.
J Bone Joint Surg Am. 2018 Jan 3;100(1):e1. doi: 10.2106/JBJS.16.01623.
High tibial osteotomy with acute correction and internal fixation can be used to correct malalignment and malorientation and reduce symptoms in patients with medial compartment osteoarthritis of the knee. To address the inadequacies of this technique, we performed a series of subtubercle tibial osteotomy (STO) procedures using circular ring fixation to correct knee varus malalignment and joint malorientation. The purpose of this study was to analyze the ability of this technique to delay subsequent knee arthroplasty and decrease symptoms.
Sixty-one patients had a total of 72 STO procedures using the Ilizarov technique to correct a varus deformity of the proximal part of the tibia. Radiographic measurements were performed at the time of presentation and after osseous union and frame removal. Clinical and radiographic variables were compared from presentation to the time of the latest follow-up. We performed a survival analysis, and our primary outcome was the time to conversion to knee arthroplasty.
Radiographic measurements, including mechanical axis deviation, medial proximal tibial angle, and joint line congruence angle, significantly improved after deformity correction (p < 0.001 for all). In patients with a preoperative flexion contracture, the proximal posterior tibial angle significantly increased toward normal values (mean, 77.8° pretreatment versus 82.4° posttreatment; p = 0.007). Survival analysis demonstrated a rate of native knee-joint survival without conversion to arthroplasty of 94.2% (95% confidence interval [CI], 83% to 98%) at 5 years, 84.0% (95% CI, 69% to 92%) at 10 years, and 51.3% (95% CI, 28% to 71%) at 15 years. In addition, time-trade-off and Brief Pain Inventory outcomes significantly improved (p < 0.001). The complication rate was 8%.
STO procedures using the Ilizarov technique for symptomatic varus knee deformity, performed over the course of 18 years, resulted in high knee survival rates without arthroplasty and significant improvement in clinical status. The STO technique provides several advantages over acute correction with internal fixation through a conventional high tibial osteotomy, including maintenance of the patellofemoral relationship, no retained implants, and accurate coronal and sagittal plane corrections.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
胫骨高位截骨术联合急性矫正和内固定可用于矫正对线不良和倾斜，减轻膝关节内侧间室骨关节炎患者的症状。为了解决该技术的不足，我们采用环形环固定进行了一系列胫骨结节下截骨术（STO），以矫正膝关节内翻畸形和关节对线不良。本研究的目的是分析该技术延迟后续膝关节置换术和减轻症状的能力。
61 例患者共进行了 72 例 STO 手术，采用 Ilizarov 技术矫正胫骨近端的内翻畸形。在就诊时、骨愈合和框架移除后进行影像学测量。比较就诊时到随访的最新时间的临床和影像学变量。我们进行了生存分析，主要结果是转为膝关节置换术的时间。
影像学测量，包括机械轴偏差、内侧胫骨近端角和关节线吻合角，在畸形矫正后显著改善（所有均 p<0.001）。在术前存在屈曲挛缩的患者中，胫骨后上倾角显著向正常方向增加（平均，术前 77.8°，术后 82.4°；p=0.007）。生存分析显示，5 年时无膝关节置换的自然膝关节存活率为 94.2%（95%置信区间 [CI]，83%至 98%），10 年时为 84.0%（95% CI，69%至 92%），15 年时为 51.3%（95% CI，28%至 71%）。此外，时间权衡和简明疼痛量表结果显著改善（p<0.001）。并发症发生率为 8%。
18 年来，采用 Ilizarov 技术治疗症状性内翻膝关节畸形的 STO 手术，结果显示膝关节无关节置换的高存活率和临床状况的显著改善。与通过传统胫骨高位截骨术进行的急性矫正相比，STO 技术具有几个优势，包括维持髌股关系、无残留植入物和准确的冠状面和矢状面矫正。
治疗性 IV 级。请参阅作者说明，以获取完整的证据水平描述。
