Sim Jae Ang, Na Young Gon, Go Jae Yun, Lee Beom Koo
Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea.
Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Knee. 2018 Jan;25(1):177-184. doi: 10.1016/j.knee.2017.11.004. Epub 2018 Jan 9.
In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site.
The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5±9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at <2mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union).
The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus-valgus angle on the stress radiographs between the bony union and fibrous union group (1.6±1.2° vs. 1.6±0.8°, P<0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups.
Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site.
在膝内翻全膝关节置换术（TKA）中，应松解内侧软组织的病理性挛缩以平衡韧带。内侧髁上截骨术已作为一种替代方法用于此。本研究的目的是展示膝内翻TKA内侧髁上截骨术的临床和影像学结果，重点关注截骨部位的愈合类型。
本研究回顾性评估了61例患者，平均股骨胫骨角为内翻10.4°，平均屈曲挛缩角为8.5±9.8°。术中伸直位和90°屈曲位时内侧和外侧间隙差异<2mm被接受。根据截骨部位的愈合类型（骨性愈合或纤维性愈合）将患者分为两组，比较两组的临床结果（膝关节协会评分、活动范围）和影像学结果（冠状位对线和外翻稳定性）。
在最近一次随访时，临床和影像学结果均有显著改善。39例（63.9%）患者实现了骨性愈合，而22例患者为纤维性愈合。骨性愈合组和纤维性愈合组在应力X线片上的内外翻角度无差异（1.6±1.2°对1.6±0.8°，P<0.916）。两组之间的膝关节协会评分（膝关节、功能）、活动范围和影像学对线无差异。
内侧髁上截骨术是TKA期间间隙平衡的一个良好选择，因为无论截骨部位的愈合类型如何，它都能提供令人满意的临床和影像学结果。
